Provider Demographics
NPI:1134394125
Name:LAWRENCE, KATRINA N (EDD, LCPC)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:N
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 APPLE LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3078
Mailing Address - Country:US
Mailing Address - Phone:301-404-5231
Mailing Address - Fax:
Practice Address - Street 1:9332 ANNAPOLIS RD
Practice Address - Street 2:SUITE 333
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3113
Practice Address - Country:US
Practice Address - Phone:301-404-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2724101YP2500X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0172235 00Medicaid