Provider Demographics
NPI:1740635895
Name:LAWRENCE, TANYA (CADC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E 125TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1004
Mailing Address - Country:US
Mailing Address - Phone:424-703-7428
Mailing Address - Fax:
Practice Address - Street 1:1516 E 125TH ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1004
Practice Address - Country:US
Practice Address - Phone:424-703-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA00477119376K00000X
CA7848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide