Provider Demographics
NPI:1811108335
Name:NORMAN, LAURA UPTON (MED LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:UPTON
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WEST COLEMAN BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-270-0680
Mailing Address - Fax:843-881-0358
Practice Address - Street 1:222 WEST COLEMAN BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-270-0680
Practice Address - Fax:843-881-0358
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist