Provider Demographics
NPI:1225584139
Name:MACKLIN, LAURA (LCMHC, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:LCMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 WATERS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2860
Mailing Address - Country:US
Mailing Address - Phone:801-971-2008
Mailing Address - Fax:
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-819-6126
Practice Address - Fax:757-819-6292
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006633101YM0800X
UT7133302-6004101YM0800X
NY004415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health