Provider Demographics
NPI:1649984154
Name:ROSS, LAUREN KIMBERLY (LMFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KIMBERLY
Last Name:ROSS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 TODDVILLE RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2435
Mailing Address - Country:US
Mailing Address - Phone:704-219-8095
Mailing Address - Fax:
Practice Address - Street 1:1646 TODDVILLE RD UNIT 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2435
Practice Address - Country:US
Practice Address - Phone:704-219-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist