Provider Demographics
NPI:1770770869
Name:TEIXEIRA, LAURIE A (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4729
Mailing Address - Country:US
Mailing Address - Phone:912-604-3983
Mailing Address - Fax:844-605-1874
Practice Address - Street 1:10375 FORD AVE STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-9037
Practice Address - Country:US
Practice Address - Phone:912-604-3983
Practice Address - Fax:844-605-1874
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0024881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical