Provider Demographics
NPI:1679234215
Name:PIERCE, LAURA MARINN (PHD, LPCC, LCMHCA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARINN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PHD, LPCC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 CORPORATE CENTER DR STE 100F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4594
Mailing Address - Country:US
Mailing Address - Phone:704-387-4805
Mailing Address - Fax:
Practice Address - Street 1:11230 CARMEL COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3920
Practice Address - Country:US
Practice Address - Phone:704-387-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-15436101YM0800X
CA567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional