Provider Demographics
NPI:1548397094
Name:DAUGHTERY, LAURA GENE (LCSW-C)
Entity Type:Individual
Prefix:PROF
First Name:LAURA
Middle Name:GENE
Last Name:DAUGHTERY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12113 IVORY FASHION CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2800
Mailing Address - Country:US
Mailing Address - Phone:301-490-6355
Mailing Address - Fax:
Practice Address - Street 1:12113 IVORY FASHION CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2800
Practice Address - Country:US
Practice Address - Phone:301-490-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110631041C0700X
DCLC3035391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical