Provider Demographics
NPI:1437820255
Name:BARDWELL, LAURIE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:MICHELLE
Last Name:BARDWELL
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 1:132 FLAGON LOOP
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3761
Mailing Address - Country:US
Mailing Address - Phone:318-715-7456
Mailing Address - Fax:
Practice Address - Street 1:132 FLAGON LOOP
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-3761
Practice Address - Country:US
Practice Address - Phone:318-715-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker