Provider Demographics
NPI:1306844584
Name:LAWRENCE, JOAN ALFREDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ALFREDA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 MONROE STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-885-4121
Mailing Address - Fax:419-885-6121
Practice Address - Street 1:6400 MONROE STREET
Practice Address - Street 2:SUITE E
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-885-4121
Practice Address - Fax:419-885-6121
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4724103TC0700X
MI6301008622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
03283OtherPARAMOUNT
OH2085327Medicaid
OH2085327Medicaid