Provider Demographics
NPI:1649811001
Name:LAWRENCE, DAKOTA KENNEDY
Entity type:Individual
Prefix:MR
First Name:DAKOTA
Middle Name:KENNEDY
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 1:2308 ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2112
Mailing Address - Country:US
Mailing Address - Phone:904-583-7879
Mailing Address - Fax:
Practice Address - Street 1:3841 GREEN HILLS VILLAGE DR RM 3000-C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2691
Practice Address - Country:US
Practice Address - Phone:615-510-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health