Provider Demographics
NPI:1790555241
Name:LAURA GOLD, LICSW PLLC
Entity Type:Organization
Organization Name:LAURA GOLD, LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW
Authorized Official - Phone:205-708-6440
Mailing Address - Street 1:1130 UNIVERSITY BLVD STE B9
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-0328
Mailing Address - Country:US
Mailing Address - Phone:415-307-3534
Mailing Address - Fax:
Practice Address - Street 1:700 ENERGY CENTER BLVD STE 402
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-2793
Practice Address - Country:US
Practice Address - Phone:205-708-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)