Provider Demographics
NPI:1629199088
Name:STROUD, LAURA RUBY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUBY
Last Name:STROUD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CROWNE CHASE DR
Mailing Address - Street 2:APT 16
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3583
Mailing Address - Country:US
Mailing Address - Phone:336-407-0399
Mailing Address - Fax:
Practice Address - Street 1:501 SHEPHERD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1698
Practice Address - Country:US
Practice Address - Phone:336-760-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical