MEDICARE: MR. LAWRENCE CARTER LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist	15374	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15374	TX

General Provider Information

NPI Number	:	1831859701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE CARTER LCDC

Provider Business Mailing Address
First Line	:	8950 VERMILLION ST APT 1105
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-1615
Country	:	US
Telephone Number	:	214-734-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 KRAFT ST STE 30
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5410
Country	:	US
Telephone Number	:	817-522-5138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	01/21/2022

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