Provider Demographics
NPI:1922562420
Name:NESBIT, LAUREL (MED, EDS, LMHC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:NESBIT
Suffix:
Gender:F
Credentials:MED, EDS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3720
Mailing Address - Country:US
Mailing Address - Phone:352-262-2052
Mailing Address - Fax:
Practice Address - Street 1:3190 RADIO RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-1918
Practice Address - Country:US
Practice Address - Phone:352-392-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health