Provider Demographics
NPI:1356663975
Name:SOTILLO, LAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SOTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 HERITAGE TRADE DRIVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-275-0608
Mailing Address - Fax:919-263-8538
Practice Address - Street 1:3206 HERITAGE TRADE DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-275-0608
Practice Address - Fax:919-263-8538
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical