Provider Demographics
NPI:1306265210
Name:SMITH, LAURA (LPCA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19120 CHANDLERS LANDING DR
Mailing Address - Street 2:APT 303
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4519
Mailing Address - Country:US
Mailing Address - Phone:336-682-1934
Mailing Address - Fax:
Practice Address - Street 1:1303 GREENSBORO STREET EXT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-1924
Practice Address - Country:US
Practice Address - Phone:336-249-0237
Practice Address - Fax:336-243-7685
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional