Provider Demographics
NPI:1548485774
Name:LAWRENCE, TRINA (MSR, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7658 FOREST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-6867
Mailing Address - Country:US
Mailing Address - Phone:770-944-6155
Mailing Address - Fax:
Practice Address - Street 1:460 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1504
Practice Address - Country:US
Practice Address - Phone:404-523-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist