Provider Demographics
NPI:1083651608
Name:THOMAS, LAUREEN BELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:BELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0357
Mailing Address - Country:US
Mailing Address - Phone:919-776-8831
Mailing Address - Fax:919-776-2177
Practice Address - Street 1:321A COURT SQ
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5658
Practice Address - Country:US
Practice Address - Phone:919-776-8831
Practice Address - Fax:919-776-2177
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00236097OtherRRCARE
NC6003583Medicaid
NC6002820Medicaid
NC6002820Medicaid
NC6003583Medicaid