Provider Demographics
NPI:1477700375
Name:WEST, LAURA M (LAURA WEST)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:LAURA WEST
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LAMFT, LAPC
Mailing Address - Street 1:3534 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4459
Mailing Address - Country:US
Mailing Address - Phone:678-624-0310
Mailing Address - Fax:678-624-0258
Practice Address - Street 1:3534 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4459
Practice Address - Country:US
Practice Address - Phone:678-624-0310
Practice Address - Fax:678-624-0258
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000140101YP2500X
GAAPC001760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional