Provider Demographics
NPI:1265849913
Name:LAWRENCE, MELISSA MONIQUE (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MONIQUE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 BRIGHTON BAY BLVD NE APT 6304
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3494
Mailing Address - Country:US
Mailing Address - Phone:718-974-9341
Mailing Address - Fax:
Practice Address - Street 1:165 WELLS RD STE 304
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-720-4040
Practice Address - Fax:904-720-4596
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10142101YP2500X
FL19207101YM0800X
010142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional