Provider Demographics
NPI:1689759078
Name:SHALER, LAUREL (PHD, LISW-CP, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:SHALER
Suffix:
Gender:F
Credentials:PHD, LISW-CP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ARUNDEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1304
Mailing Address - Country:US
Mailing Address - Phone:864-380-4288
Mailing Address - Fax:
Practice Address - Street 1:2502B WADE HAMPTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-380-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-07-05
Deactivation Date:2012-09-17
Deactivation Code:
Reactivation Date:2013-06-14
Provider Licenses
StateLicense IDTaxonomies
VA09040083341041C0700X
SC85061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical