Provider Demographics
NPI:1437799103
Name:LAWRENCE, TYLER LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:LAURA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 BAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9797
Mailing Address - Country:US
Mailing Address - Phone:704-920-9691
Mailing Address - Fax:
Practice Address - Street 1:1959 N PEACE
Practice Address - Street 2:104
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-560-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst