Provider Demographics
NPI:1780446641
Name:DAVID, LAURA MARY (RMHC-I)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARY
Last Name:DAVID
Suffix:
Gender:F
Credentials:RMHC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15318 PALOMAPARK LN
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4812
Mailing Address - Country:US
Mailing Address - Phone:813-648-2569
Mailing Address - Fax:
Practice Address - Street 1:15318 PALOMAPARK LN
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4812
Practice Address - Country:US
Practice Address - Phone:813-648-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional