Provider Demographics
NPI:1841716057
Name:WELBORN, LAURA ECKLES (LCAS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ECKLES
Last Name:WELBORN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4215
Mailing Address - Country:US
Mailing Address - Phone:336-838-0787
Mailing Address - Fax:336-667-6694
Practice Address - Street 1:911 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4215
Practice Address - Country:US
Practice Address - Phone:336-838-0787
Practice Address - Fax:336-667-6694
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23350101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)