Individual
MRS. TANISHA LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8705 W MORTEN AVE, GLENDALE, AZ 85305-3944
(623) 210-5169
(602) 455-4624
Mailing address
8030 W OREGON AVE, GLENDALE, AZ 85303-5547
(623) 210-5169
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
571686
AZ
385HR2055X
Child Mental Illness Respite Care
571686
AZ
Other
Enumeration date
02/27/2008
Last updated
03/19/2020
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