Provider Demographics
NPI:1518248780
Name:MOSEDALE, LAURA PERRY (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:PERRY
Last Name:MOSEDALE
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 1:318 JULIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3914
Mailing Address - Country:US
Mailing Address - Phone:301-717-9972
Mailing Address - Fax:
Practice Address - Street 1:1037 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7323
Practice Address - Country:US
Practice Address - Phone:984-212-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA787251041C0700X
CAASW620131041C0700X
NCC0138921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical