Provider Demographics
NPI:1396577037
Name:DARKE, LAURA L (PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:DARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 GAYLEY AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3417
Mailing Address - Country:US
Mailing Address - Phone:310-208-1077
Mailing Address - Fax:310-570-1012
Practice Address - Street 1:1033 GAYLEY AVE STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3417
Practice Address - Country:US
Practice Address - Phone:310-208-1077
Practice Address - Fax:310-570-1012
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical