Provider Demographics
NPI:1205482619
Name:WAMPLER, LAURA K (CSAC-I, CPSS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:K
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:CSAC-I, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 WOODSWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-4655
Mailing Address - Country:US
Mailing Address - Phone:336-479-3716
Mailing Address - Fax:
Practice Address - Street 1:423 WOODSWAY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-4655
Practice Address - Country:US
Practice Address - Phone:336-479-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-5717-01175T00000X
NCCSAC24262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist