Provider Demographics
NPI:1407086606
Name:KING, LAURA DIANE (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:KING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD
Mailing Address - Street 2:SUITE L-101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3150
Mailing Address - Country:US
Mailing Address - Phone:443-676-2645
Mailing Address - Fax:443-676-2645
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:SUITE L-101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3150
Practice Address - Country:US
Practice Address - Phone:443-676-2645
Practice Address - Fax:443-676-2645
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor