Provider Demographics
NPI:1831209386
Name:LAURIA, EDWARD C (MS, LMFT, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:C
Last Name:LAURIA
Suffix:
Gender:M
Credentials:MS, LMFT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5832
Mailing Address - Country:US
Mailing Address - Phone:770-518-8600
Mailing Address - Fax:678-518-3922
Practice Address - Street 1:1102 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5832
Practice Address - Country:US
Practice Address - Phone:770-518-8600
Practice Address - Fax:678-518-3922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1728101YP2500X
GA755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist