Provider Demographics
NPI:1790468932
Name:MASSEY, LAURA DIANNE (LCAS, LCMHCA, SAP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DIANNE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LCAS, LCMHCA, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-2206
Mailing Address - Country:US
Mailing Address - Phone:980-785-4601
Mailing Address - Fax:
Practice Address - Street 1:104 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-2206
Practice Address - Country:US
Practice Address - Phone:980-785-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS28531101YA0400X
NCA17890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)