Provider Demographics
NPI:1477859007
Name:CONWAY, LAURA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 W ROOSEVELT BLVD
Mailing Address - Street 2:#110
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-0453
Mailing Address - Country:US
Mailing Address - Phone:704-219-7613
Mailing Address - Fax:704-446-9104
Practice Address - Street 1:2661 W ROOSEVELT BLVD
Practice Address - Street 2:#110
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0453
Practice Address - Country:US
Practice Address - Phone:704-219-7613
Practice Address - Fax:704-446-9104
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health