Provider Demographics
NPI:1578978615
Name:CLOSEN, LAUREN BREEDLOVE (MS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BREEDLOVE
Last Name:CLOSEN
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:BREEDLOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:3403 ARSENAL CT APT 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7200
Mailing Address - Country:US
Mailing Address - Phone:704-451-6673
Mailing Address - Fax:
Practice Address - Street 1:769 N WENDOVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1118
Practice Address - Country:US
Practice Address - Phone:704-376-7180
Practice Address - Fax:704-531-9266
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10966101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health