Provider Demographics
NPI:1790174894
Name:VALENTINE, LAURA MARY (MA, NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 HAMPSTEAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6740
Mailing Address - Country:US
Mailing Address - Phone:919-358-3012
Mailing Address - Fax:
Practice Address - Street 1:4111 HAMPSTEAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6740
Practice Address - Country:US
Practice Address - Phone:919-358-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health