Provider Demographics
NPI:1285751495
Name:DETERVILLE, LAURA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DETERVILLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SHEKUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:611 N CHURCH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-3620
Mailing Address - Country:US
Mailing Address - Phone:828-393-5913
Mailing Address - Fax:828-595-2029
Practice Address - Street 1:611 N CHURCH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-3620
Practice Address - Country:US
Practice Address - Phone:828-393-5913
Practice Address - Fax:828-595-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional