Provider Demographics
NPI:1457545527
Name:LAWRENCE, LINDA MARY (PSYS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARY
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22811 MACK AVE
Mailing Address - Street 2:SUITE L-3
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2021
Mailing Address - Country:US
Mailing Address - Phone:586-777-0470
Mailing Address - Fax:586-777-9879
Practice Address - Street 1:22811 MACK AVE
Practice Address - Street 2:SUITE L-3
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2021
Practice Address - Country:US
Practice Address - Phone:586-777-0470
Practice Address - Fax:586-777-9879
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010766103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist