Healthcare Provider Details

I. General information

NPI: 1548485774
Provider Name (Legal Business Name): TRINA LAWRENCE MSR, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 AUBURN AVE NE
ATLANTA GA
30312-1504
US

IV. Provider business mailing address

7658 FOREST GLEN WAY
LITHIA SPRINGS GA
30122-6867
US

V. Phone/Fax

Practice location:
  • Phone: 404-523-1613
  • Fax:
Mailing address:
  • Phone: 770-944-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: