Provider Demographics
NPI:1659550242
Name:MCLAURIN, CHARLENE ARNETTA (MED)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ARNETTA
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 COTTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2938
Mailing Address - Country:US
Mailing Address - Phone:910-424-4701
Mailing Address - Fax:
Practice Address - Street 1:6136 COTTAGE WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2938
Practice Address - Country:US
Practice Address - Phone:910-424-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional