Provider Demographics
NPI:1144248360
Name:LAWRENCE, REBECCA WEST (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:WEST
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MARY ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3355
Mailing Address - Country:US
Mailing Address - Phone:843-937-3997
Mailing Address - Fax:
Practice Address - Street 1:939 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7266
Practice Address - Country:US
Practice Address - Phone:910-742-9243
Practice Address - Fax:888-746-1787
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-04-14
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
NY249946-12084P0800X
SC896192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04424168Medicaid
11978443Medicare UPIN