Provider Demographics
NPI:1023479078
Name:LAWRENCE, MICHELLE (LMHC/MCAP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMHC/MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 BURTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8013
Mailing Address - Country:US
Mailing Address - Phone:850-480-9314
Mailing Address - Fax:
Practice Address - Street 1:4210 BURTONWOOD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-8013
Practice Address - Country:US
Practice Address - Phone:850-480-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC0118802015101YA0400X
FLMH17924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)