Provider Demographics
NPI:1154721207
Name:DISANTIS, LAURA KAY (LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KAY
Last Name:DISANTIS
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 1:365 FRANKLIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8921
Mailing Address - Country:US
Mailing Address - Phone:724-543-1888
Mailing Address - Fax:724-543-1898
Practice Address - Street 1:365 FRANKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8921
Practice Address - Country:US
Practice Address - Phone:724-543-1888
Practice Address - Fax:724-543-1898
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007409101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health