Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003083015 |
---|---|
Provider Name | Stella O Lawrence |
First Address | Los Angeles, CA 90047 |
Second Address | Los Angeles, CA 90047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 09/05/2008 |