Provider Demographics
NPI:1710003298
Name:NORRIS, LAURA DIANE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 W MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93650-1066
Mailing Address - Country:US
Mailing Address - Phone:559-266-9581
Mailing Address - Fax:559-498-0507
Practice Address - Street 1:539 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3419
Practice Address - Country:US
Practice Address - Phone:559-266-9581
Practice Address - Fax:559-498-0507
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669559878OtherART NPI NUMBER