Provider Demographics
NPI:1992375174
Name:CHRISTIANSON, LAURA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6268 OLD BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5505
Mailing Address - Country:US
Mailing Address - Phone:850-353-2677
Mailing Address - Fax:850-505-3067
Practice Address - Street 1:6268 OLD BETHEL RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5505
Practice Address - Country:US
Practice Address - Phone:850-353-2677
Practice Address - Fax:850-505-3067
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW159251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical