Provider Demographics
NPI:1003817891
Name:LAUREL, LORABEL FEROLIN (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:LORABEL
Middle Name:FEROLIN
Last Name:LAUREL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 DRIFTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7897
Mailing Address - Country:US
Mailing Address - Phone:757-258-3865
Mailing Address - Fax:
Practice Address - Street 1:4601 IRONBOUND RD
Practice Address - Street 2:EASTERN STATE HOSPITAL
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2652
Practice Address - Country:US
Practice Address - Phone:757-253-5327
Practice Address - Fax:757-253-4521
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022091261835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202209126Medicare PIN