Provider Demographics
NPI:1194211904
Name:WINSTON, LAWRENCE ANTHONY (BA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ANTHONY
Last Name:WINSTON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 S CIMARRON RD UNIT 4118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-2544
Mailing Address - Country:US
Mailing Address - Phone:213-884-8642
Mailing Address - Fax:
Practice Address - Street 1:3095 E RUSSELL RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5400
Practice Address - Country:US
Practice Address - Phone:702-685-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical