Provider Demographics
NPI:1568202208
Name:WORRELL, LAURA (LCMHC-A, NCC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WORRELL
Suffix:
Gender:F
Credentials:LCMHC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206B BRIDGEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-8511
Mailing Address - Country:US
Mailing Address - Phone:910-998-7959
Mailing Address - Fax:
Practice Address - Street 1:1209 MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4346
Practice Address - Country:US
Practice Address - Phone:910-833-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health