Provider Demographics
NPI:1104101583
Name:LAWRENCE, REBECCA ANN (LMFT, RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 ALDER RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8820
Mailing Address - Country:US
Mailing Address - Phone:707-464-6477
Mailing Address - Fax:
Practice Address - Street 1:2721 ALDER RD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8820
Practice Address - Country:US
Practice Address - Phone:707-464-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37503101YM0800X
CA780931163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse