Provider Demographics
NPI:1407138894
Name:CONN, LAURA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:CONN
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 1:18 EDINBURGH PL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-7513
Mailing Address - Country:US
Mailing Address - Phone:919-805-0558
Mailing Address - Fax:
Practice Address - Street 1:18 EDINBURGH PL
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527
Practice Address - Country:US
Practice Address - Phone:919-805-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1800101YA0400X
NCCOO85781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)