Provider Demographics
NPI:1144589623
Name:LARA E. GERRARD, MA, LPA PSYCHOEDUCATIONAL EVALUATIONS
Entity Type:Organization
Organization Name:LARA E. GERRARD, MA, LPA PSYCHOEDUCATIONAL EVALUATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-738-0352
Mailing Address - Street 1:668 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4233
Mailing Address - Country:US
Mailing Address - Phone:919-738-0352
Mailing Address - Fax:
Practice Address - Street 1:668 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4233
Practice Address - Country:US
Practice Address - Phone:919-738-0352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty