Provider Demographics
NPI:1861197915
Name:LAWRENCE, CHELSEA ROSE (SSP, NCSP)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:ROSE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:SSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 TIMBERLIN PARK BLVD APT 721
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6739
Mailing Address - Country:US
Mailing Address - Phone:305-299-4890
Mailing Address - Fax:
Practice Address - Street 1:7635 TIMBERLIN PARK BLVD APT 721
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6739
Practice Address - Country:US
Practice Address - Phone:305-299-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool