Provider Demographics
NPI:1467694117
Name:CARRAWAY, LAURA MARIE (LCAS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 ALBRIGHT DR
Mailing Address - Street 2:PSYCHOTHERAPEUTIC SERVICES
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5415
Mailing Address - Country:US
Mailing Address - Phone:336-836-9664
Mailing Address - Fax:336-834-9698
Practice Address - Street 1:3 CENTERVIEW DR
Practice Address - Street 2:PSYCHOTHERAPEUTIC SERVICES
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3725
Practice Address - Country:US
Practice Address - Phone:336-836-9664
Practice Address - Fax:336-834-9698
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1570101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)