Provider Demographics
NPI:1093032054
Name:MACHADO, LAURA (LAPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 PIERCE IVY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-1316
Mailing Address - Country:US
Mailing Address - Phone:770-662-0249
Mailing Address - Fax:770-449-5023
Practice Address - Street 1:6020 DAWSON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1225
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:770-449-5023
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
GAAPC002403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)