Provider Demographics
NPI:1538332051
Name:WHITSON, LAURA M (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:WHITSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:BORUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:2243 EDDIE WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2872
Practice Address - Country:US
Practice Address - Phone:423-928-5627
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant