Provider Demographics
NPI:1659857225
Name:BIRCH, LAUREL MEGHAN (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:MEGHAN
Last Name:BIRCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:LUKKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2830 MISSY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4327
Mailing Address - Country:US
Mailing Address - Phone:770-589-0144
Mailing Address - Fax:
Practice Address - Street 1:2830 MISSY DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4327
Practice Address - Country:US
Practice Address - Phone:770-589-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011740101Y00000X
LA6319101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6319OtherLICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS
GALPC011740OtherBOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS, AND MARRIAGE & FAMILY THERAPIS