Provider Demographics
NPI:1558938910
Name:LAWRENCE, CHELSEA NICOLE (EDS)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:NICOLE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1700
Mailing Address - Country:US
Mailing Address - Phone:727-403-8992
Mailing Address - Fax:
Practice Address - Street 1:1211 1ST AVE N STE 211
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1547
Practice Address - Country:US
Practice Address - Phone:727-248-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health