Basic Information
| Provider Information | |||||||||
| NPI: | 1790901122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | GAY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 BUCKINGHAM ROAD | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177556531 | ||||||||
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| Practice Location | |||||||||
| Address1: | 79 W ALEXANDRINE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138315535 | ||||||||
| FaxNumber: | 3138312608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MSW003154 | GA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 6801102037 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.