Provider Demographics
NPI:1124830575
Name:BECKER, LAUREN BRENNA (LAC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRENNA
Last Name:BECKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 N SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6621
Mailing Address - Country:US
Mailing Address - Phone:240-472-7722
Mailing Address - Fax:
Practice Address - Street 1:1 CARRIAGE LN STE B101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6043
Practice Address - Country:US
Practice Address - Phone:843-790-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist