Provider Demographics
NPI:1124253455
Name:HARBESON, LAURA RAEUNN MARIE (PHD, LCMHCS, NCC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:RAEUNN MARIE
Last Name:HARBESON
Suffix:
Gender:F
Credentials:PHD, LCMHCS, NCC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:GREENHALGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:2620 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-7457
Mailing Address - Country:US
Mailing Address - Phone:980-581-8144
Mailing Address - Fax:980-581-8148
Practice Address - Street 1:2620 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-7457
Practice Address - Country:US
Practice Address - Phone:980-581-8144
Practice Address - Fax:980-581-8148
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS7373101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104276Medicaid