Provider Demographics
NPI:1003277039
Name:LAWRENCE, ANNA LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 N AINSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7987
Mailing Address - Country:US
Mailing Address - Phone:208-277-5114
Mailing Address - Fax:208-263-4198
Practice Address - Street 1:207 LARKSPUR ST
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-5011
Practice Address - Country:US
Practice Address - Phone:208-255-3314
Practice Address - Fax:208-263-4198
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW267591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW26759OtherSW LICENSE