Provider Demographics
NPI:1952526469
Name:PIERCE, LAWRENCE EARL
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EARL
Last Name:PIERCE
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 1:4119 FRONT ST
Mailing Address - Street 2:#5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2048
Mailing Address - Country:US
Mailing Address - Phone:619-302-1819
Mailing Address - Fax:
Practice Address - Street 1:4119 FRONT ST
Practice Address - Street 2:#5
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2048
Practice Address - Country:US
Practice Address - Phone:619-302-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health