Provider Demographics
NPI:1821559907
Name:LAUGHLIN, DAVID CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:LAUGHLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 40TH ST S UNIT B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1184
Mailing Address - Country:US
Mailing Address - Phone:701-478-8440
Mailing Address - Fax:651-925-0046
Practice Address - Street 1:505 40TH ST S UNIT B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1184
Practice Address - Country:US
Practice Address - Phone:701-478-8440
Practice Address - Fax:651-925-0046
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND510183396Medicaid