Basic Information
| Provider Information | |||||||||
| NPI: | 1043548902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARCLAY | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | DEMETRIUS | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5108 MCCLELLAN BLVD | ||||||||
| Address2: | APT 129 | ||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362061874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2453220373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 GOODYEAR AVE | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359031106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564927800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2009 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6930784 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.