Provider Demographics
NPI:1013767615
Name:THOMPSON, LARAVEN DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:LARAVEN
Middle Name:DANIELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARAVEN
Other - Middle Name:DANIELLE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13040 ARDMORE FOREST RD APT 306
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-0220
Mailing Address - Country:US
Mailing Address - Phone:864-650-3277
Mailing Address - Fax:
Practice Address - Street 1:8848 RED OAK BLVD STE AA
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5595
Practice Address - Country:US
Practice Address - Phone:980-422-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist