Provider Demographics
NPI:1154417285
Name:HUDDLESTON, LAURA D (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LEE HWY
Mailing Address - Street 2:ST 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2452
Mailing Address - Country:US
Mailing Address - Phone:423-899-5081
Mailing Address - Fax:423-490-0410
Practice Address - Street 1:6400 LEE HWY
Practice Address - Street 2:ST 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2452
Practice Address - Country:US
Practice Address - Phone:423-899-5081
Practice Address - Fax:423-490-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4750818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional