Provider Demographics
NPI:1346844370
Name:LEBOLD, LAURIE FOUTS (LPC, LMFT, CRC)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:FOUTS
Last Name:LEBOLD
Suffix:
Gender:F
Credentials:LPC, LMFT, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10056 DOE RUN PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-6217
Mailing Address - Country:US
Mailing Address - Phone:804-536-2755
Mailing Address - Fax:
Practice Address - Street 1:4908 MONUMENT AVE STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3613
Practice Address - Country:US
Practice Address - Phone:804-381-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional