Provider Demographics
NPI:1649678715
Name:DAVIES, LAURA (LCSWA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BRADFORD VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5451
Mailing Address - Country:US
Mailing Address - Phone:910-692-2947
Mailing Address - Fax:910-692-4127
Practice Address - Street 1:105 BRADFORDF VILLAGE COURT
Practice Address - Street 2:BRADFORD ASSOCIATES NC LLC
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-692-2947
Practice Address - Fax:910-692-4127
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health