Provider Demographics
NPI:1972869733
Name:LAU, CHRISTINE ELLSWORTH (RN, LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELLSWORTH
Last Name:LAU
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Gender:F
Credentials:RN, LCSW
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Mailing Address - Street 1:571 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9447
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:828-665-2142
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9447
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-665-2142
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCC0052091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical