Provider Demographics
NPI:1558826669
Name:LAWRENCE, BRITTANY YOUNGBLOOD (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:YOUNGBLOOD
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2583
Mailing Address - Country:US
Mailing Address - Phone:757-664-9778
Mailing Address - Fax:
Practice Address - Street 1:4914 FALCON NEST PL APT 203
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-0847
Practice Address - Country:US
Practice Address - Phone:252-622-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77365106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician