Provider Demographics
NPI:1033893375
Name:PICKELSIMER, LAURA N
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:PICKELSIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BEAVER RUN
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-3032
Mailing Address - Country:US
Mailing Address - Phone:706-972-0096
Mailing Address - Fax:
Practice Address - Street 1:234 BEAVER RUN
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-3032
Practice Address - Country:US
Practice Address - Phone:706-972-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician