Provider Demographics
NPI:1255957965
Name:FALES, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 CRAWFORD ST STE 816
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2825
Mailing Address - Country:US
Mailing Address - Phone:757-966-2715
Mailing Address - Fax:
Practice Address - Street 1:355 CRAWFORD ST STE 816
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2825
Practice Address - Country:US
Practice Address - Phone:757-966-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional