Provider Demographics
NPI:1063548956
Name:LINK, LAUREL MARLENE (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:MARLENE
Last Name:LINK
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SILAS CREEK PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3823
Mailing Address - Country:US
Mailing Address - Phone:336-293-8900
Mailing Address - Fax:336-293-8900
Practice Address - Street 1:4400 SILAS CREEK PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3823
Practice Address - Country:US
Practice Address - Phone:336-293-8900
Practice Address - Fax:336-293-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2193101YP2500X
NC471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95790OtherMEDCOST
NC52338OtherBCBS