Provider Demographics
NPI:1265868871
Name:LAWRENCE, GRANT
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CONTINENTAL AVE
Mailing Address - Street 2:APT. 230
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1708
Mailing Address - Country:US
Mailing Address - Phone:321-431-4583
Mailing Address - Fax:
Practice Address - Street 1:1000 W THARPE ST
Practice Address - Street 2:SUITE. 7
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5374
Practice Address - Country:US
Practice Address - Phone:850-561-8060
Practice Address - Fax:850-561-1143
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical