Provider Demographics
NPI:1538300033
Name:GHOLAR, LAUREATE B III
Entity Type:Individual
Prefix:MR
First Name:LAUREATE
Middle Name:B
Last Name:GHOLAR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MONTE CRESTA AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4850
Mailing Address - Country:US
Mailing Address - Phone:510-926-1228
Mailing Address - Fax:
Practice Address - Street 1:303 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4340
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health