Provider Demographics
NPI:1871378844
Name:KIRKLAND, LAWANNA
Entity type:Individual
Prefix:MRS
First Name:LAWANNA
Middle Name:
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 TOWN RD SW BAY FL574
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7539
Mailing Address - Country:US
Mailing Address - Phone:772-646-5008
Mailing Address - Fax:
Practice Address - Street 1:574 TOWN RD SW BAY FL
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7539
Practice Address - Country:US
Practice Address - Phone:772-646-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health