Provider Demographics
NPI:1275587925
Name:BASS, LAURA A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:BASS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 SPRINGBANK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3197
Mailing Address - Country:US
Mailing Address - Phone:704-540-5566
Mailing Address - Fax:704-540-5664
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3197
Practice Address - Country:US
Practice Address - Phone:704-540-5566
Practice Address - Fax:704-540-5664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2866114BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER