Provider Demographics
NPI:1831247352
Name:PATRICE, LAURIE LANCASTER (LPC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LANCASTER
Last Name:PATRICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:PATRICE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3455 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6425
Mailing Address - Country:US
Mailing Address - Phone:770-634-3285
Mailing Address - Fax:404-201-2103
Practice Address - Street 1:3455 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6425
Practice Address - Country:US
Practice Address - Phone:770-634-3285
Practice Address - Fax:404-201-2103
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3972101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA266292119AMedicaid