Healthcare Provider Details

I. General information

NPI: 1699809228
Provider Name (Legal Business Name): ANNE LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6306 CENTRAL AVE SW
ALBUQUERQUE NM
87105-2035
US

IV. Provider business mailing address

20 CAMPO RD
TIJERAS NM
87059-7648
US

V. Phone/Fax

Practice location:
  • Phone: 505-352-3465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMHC0081901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: