Provider Demographics
NPI:1689937203
Name:LAWRENCE, MICHELLE D (BS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 PINEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1963
Mailing Address - Country:US
Mailing Address - Phone:407-731-6488
Mailing Address - Fax:
Practice Address - Street 1:5324 PINEVIEW WAY
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1963
Practice Address - Country:US
Practice Address - Phone:407-731-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-3742-006-08253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency