Provider Demographics
NPI:1598316408
Name:MCLAURIN, PAMELA LATRES (LCAS(A))
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LATRES
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:LCAS(A)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LIVINGSTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4400
Mailing Address - Country:US
Mailing Address - Phone:704-832-2229
Mailing Address - Fax:828-236-9825
Practice Address - Street 1:4344 S NC HIGHWAY 150 STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5376
Practice Address - Country:US
Practice Address - Phone:800-320-4157
Practice Address - Fax:336-553-9175
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25417OtherLICENSE