Provider Demographics
NPI:1255307351
Name:ECKLES, LAURIE DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:DIANE
Last Name:ECKLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:DIANE
Other - Last Name:PINTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:65 COLTON LN
Mailing Address - Street 2:
Mailing Address - City:ROARING BRANCH
Mailing Address - State:PA
Mailing Address - Zip Code:17765-9042
Mailing Address - Country:US
Mailing Address - Phone:503-680-3799
Mailing Address - Fax:
Practice Address - Street 1:65 COLTON LN
Practice Address - Street 2:
Practice Address - City:ROARING BRANCH
Practice Address - State:PA
Practice Address - Zip Code:17765-9042
Practice Address - Country:US
Practice Address - Phone:503-680-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0234601041C0700X
AZLCSW-10883101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor