Provider Demographics
NPI:1609951953
Name:TRUESDALE, LAURA L (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N LAKE DR
Mailing Address - Street 2:ADOLESCENT RECOVERY CENTER
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7653
Mailing Address - Country:US
Mailing Address - Phone:803-951-1940
Mailing Address - Fax:803-951-1963
Practice Address - Street 1:1316 N LAKE DR
Practice Address - Street 2:ADOLESCENT RECOVERY CENTER
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7653
Practice Address - Country:US
Practice Address - Phone:803-951-1940
Practice Address - Fax:803-951-1963
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0063871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical