Provider Demographics
NPI:1669024964
Name:LAWRIE, TAWANA
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:LAWRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4249
Mailing Address - Country:US
Mailing Address - Phone:614-483-3944
Mailing Address - Fax:
Practice Address - Street 1:3005 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4249
Practice Address - Country:US
Practice Address - Phone:614-483-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338065Medicaid