Provider Demographics
NPI:1790716454
Name:ATWOOD, LAURA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1416
Mailing Address - Country:US
Mailing Address - Phone:502-456-6463
Mailing Address - Fax:
Practice Address - Street 1:1676 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1416
Practice Address - Country:US
Practice Address - Phone:502-456-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY9511041C0700X
IN34004782A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical