Provider Demographics
NPI:1235398496
Name:DE GRAAF, LAURIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:DE GRAAF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 HAMMOND POND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2039
Mailing Address - Country:US
Mailing Address - Phone:803-279-7721
Mailing Address - Fax:803-279-7721
Practice Address - Street 1:308 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3816
Practice Address - Country:US
Practice Address - Phone:803-426-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist