1164647236 NPI number — MRS. LAURA KATHERINE SHERLINE LCPC

Table of content: MRS. LAURA KATHERINE SHERLINE LCPC (NPI 1164647236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164647236 NPI number — MRS. LAURA KATHERINE SHERLINE LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERLINE
Provider First Name:
LAURA
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164647236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 BOSLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-887-7665
Provider Business Mailing Address Fax Number:
410-887-7666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 BOSLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCKEYSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-887-7665
Provider Business Practice Location Address Fax Number:
410-887-7666
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC1667 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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