Provider Demographics
NPI:1720618481
Name:HARDING-FUKUSHIMA, LAURA (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HARDING-FUKUSHIMA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E EAGER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5533
Mailing Address - Country:US
Mailing Address - Phone:443-842-9943
Mailing Address - Fax:410-955-0996
Practice Address - Street 1:1000 E EAGER ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5533
Practice Address - Country:US
Practice Address - Phone:443-842-9943
Practice Address - Fax:410-955-0996
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC6060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health