Provider Demographics
NPI:1861495319
Name:RUDISILL, LAURA LEE (LCMHC-S)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:LCMHC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7639
Mailing Address - Country:US
Mailing Address - Phone:704-482-2977
Mailing Address - Fax:704-482-3501
Practice Address - Street 1:215 S WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4675
Practice Address - Country:US
Practice Address - Phone:704-482-2977
Practice Address - Fax:704-482-3501
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3261101YP2500X
NCS3261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1387YOtherBCBS
NC6102271Medicaid
NC1387YOtherBCBS