Provider Demographics
NPI:1962966879
Name:LAWRENCE, TUESDAE NICHOL (MMFT)
Entity type:Individual
Prefix:MRS
First Name:TUESDAE
Middle Name:NICHOL
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HUGH SHELTON LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3485
Mailing Address - Country:US
Mailing Address - Phone:404-513-9207
Mailing Address - Fax:
Practice Address - Street 1:2395 LOUPIN DR APT 71A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-0911
Practice Address - Country:US
Practice Address - Phone:615-823-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist