Provider Demographics
NPI:1164462271
Name:LAWRENCE, LORRAINE NIX (MFT)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:NIX
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 DEL MAR TRL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2218
Mailing Address - Country:US
Mailing Address - Phone:858-794-7809
Mailing Address - Fax:858-794-7809
Practice Address - Street 1:4145 DEL MAR TRL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2218
Practice Address - Country:US
Practice Address - Phone:858-794-7809
Practice Address - Fax:858-794-7809
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 30684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist