Provider Demographics
NPI:1881158087
Name:BOSWELL, LAURA ANN (LPC-A)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STELLA RD
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9608
Mailing Address - Country:US
Mailing Address - Phone:910-554-1880
Mailing Address - Fax:
Practice Address - Street 1:101 STELLA RD
Practice Address - Street 2:
Practice Address - City:STELLA
Practice Address - State:NC
Practice Address - Zip Code:28582-9608
Practice Address - Country:US
Practice Address - Phone:910-554-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional