Provider Demographics
NPI:1306400825
Name:STROUPE, LAURIE (SSP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:STROUPE
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W WHITNER ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-1422
Mailing Address - Country:US
Mailing Address - Phone:864-559-2592
Mailing Address - Fax:
Practice Address - Street 1:210 N MCDUFFIE ST STE 102
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5648
Practice Address - Country:US
Practice Address - Phone:864-559-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4699174400000X
SC265656103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist