Provider Demographics
NPI:1194837609
Name:DALE, LAURA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:DALE
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 1:206 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4923
Mailing Address - Country:US
Mailing Address - Phone:919-234-9014
Mailing Address - Fax:919-212-7585
Practice Address - Street 1:220 SWINBURNE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1834
Practice Address - Country:US
Practice Address - Phone:919-212-7871
Practice Address - Fax:919-212-7585
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003678Medicaid