Provider Demographics
NPI:1477007185
Name:ROBERTSON, LAURA (CATC I)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CATC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18090 BEACH BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1327
Mailing Address - Country:US
Mailing Address - Phone:714-841-3863
Mailing Address - Fax:
Practice Address - Street 1:18090 BEACH BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1327
Practice Address - Country:US
Practice Address - Phone:714-841-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167457101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)