Provider Demographics
NPI:1417572470
Name:POLLOCK, LAURA BLANDINA (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BLANDINA
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1497
Mailing Address - Country:US
Mailing Address - Phone:757-351-4244
Mailing Address - Fax:
Practice Address - Street 1:5621 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1497
Practice Address - Country:US
Practice Address - Phone:757-351-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
ALRBT-20-123761106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician