Provider Demographics
NPI:1740518042
Name:HOWARD, LAURA ANN (LADAC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:STICKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 CENTRAL AVENUE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-1400
Mailing Address - Country:US
Mailing Address - Phone:865-466-8578
Mailing Address - Fax:865-281-3274
Practice Address - Street 1:6626 CENTRAL AVENUE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1400
Practice Address - Country:US
Practice Address - Phone:865-466-8578
Practice Address - Fax:865-281-3274
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)