Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003309394 |
---|---|
Provider Name | Latoya Lawrence |
First Address | Conway, SC 29526-5521 |
Second Address | Conway, SC 29526-5521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 11/06/2018 |