Provider Demographics
NPI:1437768645
Name:LAWRENCE, ELIZABETH L (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W HIGHWAY 98 # C
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1301
Mailing Address - Country:US
Mailing Address - Phone:850-209-2423
Mailing Address - Fax:
Practice Address - Street 1:212 W HIGHWAY 98 # C
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1301
Practice Address - Country:US
Practice Address - Phone:850-209-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health