Provider Demographics
NPI:1760949366
Name:BEAVER, LAURA A (CSACR)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:BEAVER
Suffix:
Gender:F
Credentials:CSACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 AVEBURY DR APT K
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3164
Mailing Address - Country:US
Mailing Address - Phone:980-355-2290
Mailing Address - Fax:
Practice Address - Street 1:1977 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4528
Practice Address - Country:US
Practice Address - Phone:704-215-4095
Practice Address - Fax:704-271-1559
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-14152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)