Provider Demographics
NPI:1396405775
Name:CROSBY, LAURA RAHEL (LCMHCA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RAHEL
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 NEVIN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2269
Mailing Address - Country:US
Mailing Address - Phone:352-454-5029
Mailing Address - Fax:
Practice Address - Street 1:20501 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8460
Practice Address - Country:US
Practice Address - Phone:980-689-1931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health