Provider Demographics
NPI:1144319203
Name:GIPSON, LAWRENCE P
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:P
Last Name:GIPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N. MAGNOLIA
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1946
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:SWCMHC/CAF
Practice Address - Street 2:1175 N. GUIGNARD DR.
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29151-1946
Practice Address - Country:US
Practice Address - Phone:803-775-7898
Practice Address - Fax:803-773-5246
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health