Provider Demographics
NPI:1629577432
Name:CHASE, LAUREN (MS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 WAKEFIELD DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3143
Mailing Address - Country:US
Mailing Address - Phone:562-547-0665
Mailing Address - Fax:
Practice Address - Street 1:9305 MONROE RD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1490
Practice Address - Country:US
Practice Address - Phone:980-819-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst