Provider Demographics
NPI:1912425117
Name:LAWRENCE, SHANNON M (LAC, MATCM)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LAC, MATCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 CAPTAINS ROW
Mailing Address - Street 2:APT. 147
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:424-279-4854
Mailing Address - Fax:
Practice Address - Street 1:2001 S. BARRINGTON AVENUE
Practice Address - Street 2:SUITE 219
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:424-279-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17743171100000X
CA17743171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist