Individual
VIOLA DELOIS LAWRENCE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CAC-I
Contact information
Practice address
1908 RACEPATH AVE, CONWAY, SC 29527-5453
(843) 457-5553
Mailing address
1908 RACEPATH AVE, CONWAY, SC 29527-5453
(843) 457-5553
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1104017
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104017
—
SC
Enumeration date
01/04/2013
Last updated
01/04/2013
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