Provider Demographics
NPI:1225385552
Name:LAUREL, CHARLES A (MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LAUREL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EAST-WEST RD
Mailing Address - Street 2:
Mailing Address - City:E DUMMERSTON
Mailing Address - State:VT
Mailing Address - Zip Code:05346-9635
Mailing Address - Country:US
Mailing Address - Phone:802-258-8313
Mailing Address - Fax:
Practice Address - Street 1:24 EAST-WEST RD
Practice Address - Street 2:
Practice Address - City:EAST DUMMERSTON
Practice Address - State:VT
Practice Address - Zip Code:05346-9635
Practice Address - Country:US
Practice Address - Phone:802-258-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0101693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health