Provider Demographics
NPI:1669636742
Name:SIKES, LAURA SUSAN (MA, NCC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SUSAN
Last Name:SIKES
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 SAINT ELMO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1269
Mailing Address - Country:US
Mailing Address - Phone:423-802-6943
Mailing Address - Fax:888-508-6829
Practice Address - Street 1:3914 SAINT ELMO AVE STE C
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1269
Practice Address - Country:US
Practice Address - Phone:423-802-6943
Practice Address - Fax:888-508-6829
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TNLPC0000002864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional