| Doctor Name: | THERESA VACCARIELLO LAWRENCE |
| NPI Number: | 1053552711 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 180004147 |
| Business Practice Address: | 612 Oglesby Ave Normal, IL - 617611888 |
| Business Phone Number: | 3095571124 |
| Business Fax Number: | |
| Mailing Address: | 1100 Beech St, Bldg 7 NORMAL |
| State: | IL |
| Postal Code: | 617611493 |
| Phone Number: | 3095571124 |
| Fax Number: | |
| NPI Enumeration Date: | 03/10/2009 |
| NPI Last Update Date: | 03/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180004147 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |