Provider Demographics
NPI:1427349281
Name:ANTHONY, LAURA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2221
Mailing Address - Country:US
Mailing Address - Phone:864-238-4107
Mailing Address - Fax:864-751-5743
Practice Address - Street 1:110 TRADERS CROSS
Practice Address - Street 2:# 123
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4637
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0509Medicaid
SCQ353179357OtherMEDICARE PTAN