Provider Demographics
NPI:1841795499
Name:CARSON, LAURA REBECCA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:REBECCA
Last Name:CARSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3422
Mailing Address - Country:US
Mailing Address - Phone:877-557-2010
Mailing Address - Fax:
Practice Address - Street 1:222 FALLS ST APT A
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4362
Practice Address - Country:US
Practice Address - Phone:828-394-0566
Practice Address - Fax:828-608-0454
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0130591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP012250OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE