Provider Demographics
NPI:1013734532
Name:PAVLANSKY, AUDRA (LMFT)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:PAVLANSKY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:
Other - Last Name:ROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 STADIUM OAKS DR # B
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8961
Mailing Address - Country:US
Mailing Address - Phone:336-794-6769
Mailing Address - Fax:
Practice Address - Street 1:100 STADIUM OAKS DR # B
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8961
Practice Address - Country:US
Practice Address - Phone:336-794-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20132A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist