Healthcare Provider Details

I. General information

NPI: 1063626562
Provider Name (Legal Business Name): JENNIFER LORRAINE LAWRENCE LPC, LPAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LORRAINE TRINKLE

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GLENDALE DR
FREEHOLD NJ
07728
US

IV. Provider business mailing address

150 GLENDALE DR
FREEHOLD NJ
07728
US

V. Phone/Fax

Practice location:
  • Phone: 720-771-6933
  • Fax:
Mailing address:
  • Phone: 720-771-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37P00570400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16LP00003800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: