Provider Demographics
NPI:1134835887
Name:MATHEWS, LAURA (CDC-S)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:CDC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3964
Mailing Address - Country:US
Mailing Address - Phone:867-322-2286
Mailing Address - Fax:
Practice Address - Street 1:3230 C ST STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3964
Practice Address - Country:US
Practice Address - Phone:867-322-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4935101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)