Provider Demographics
NPI:1649624701
Name:LAURENCE, DAVID (BA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAURENCE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1051
Mailing Address - Country:US
Mailing Address - Phone:661-861-6141
Mailing Address - Fax:661-861-6165
Practice Address - Street 1:1120 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1051
Practice Address - Country:US
Practice Address - Phone:661-861-6141
Practice Address - Fax:661-861-6165
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health