Provider Demographics
NPI:1609247527
Name:ALCALA, LAURA JEAN (LAC, LADC, MFT-I)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:ALCALA
Suffix:
Gender:F
Credentials:LAC, LADC, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 SAINT GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:ND
Mailing Address - Zip Code:58564-4103
Mailing Address - Country:US
Mailing Address - Phone:702-485-0048
Mailing Address - Fax:
Practice Address - Street 1:7785 SAINT GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:ND
Practice Address - Zip Code:58564-4103
Practice Address - Country:US
Practice Address - Phone:701-597-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NV01349101YA0400X
NV0667106H00000X
ND1888101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1888OtherSTATE OF NORTH DAKOTA