Provider Demographics
NPI:1578713327
Name:LAWRENCE, ERICA (CIT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 5TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2156
Mailing Address - Country:US
Mailing Address - Phone:337-475-4855
Mailing Address - Fax:
Practice Address - Street 1:3505 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2156
Practice Address - Country:US
Practice Address - Phone:337-475-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)