Provider Demographics
NPI:1952452039
Name:SEITZ, LAURA A (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:SEITZ
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 ORCHARD LAKE DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1475
Mailing Address - Country:US
Mailing Address - Phone:704-844-0181
Mailing Address - Fax:904-701-6279
Practice Address - Street 1:1421 ORCHARD LAKE DR UNIT C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1475
Practice Address - Country:US
Practice Address - Phone:704-844-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X, 261QM0850X
NCC0063951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health