Healthcare Provider Details

I. General information

NPI: 1861082323
Provider Name (Legal Business Name): DANIELLE LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W BURNETT AVE
LOUISVILLE KY
40210-1616
US

IV. Provider business mailing address

2500 W BURNETT AVE
LOUISVILLE KY
40210-1616
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-8095
  • Fax:
Mailing address:
  • Phone: 317-529-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: