Provider Demographics
NPI:1568959625
Name:FORD, LAURIE
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:LATRICE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAURIE FORD, LCMHC
Mailing Address - Street 1:7024 BRANCH FORK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7389
Mailing Address - Country:US
Mailing Address - Phone:704-430-0516
Mailing Address - Fax:
Practice Address - Street 1:125 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6458
Practice Address - Country:US
Practice Address - Phone:704-430-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13886101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health