1679234215 NPI number — LAURA MARINN PIERCE PHD, LPCC, LCMHCA

Table of content: LAURA MARINN PIERCE PHD, LPCC, LCMHCA (NPI 1679234215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679234215 NPI number — LAURA MARINN PIERCE PHD, LPCC, LCMHCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
LAURA
Provider Middle Name:
MARINN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, LPCC, LCMHCA
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:
1679234215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8050 CORPORATE CENTER DR STE 100F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226-4594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-387-4805
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11230 CARMEL COMMONS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-3920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-387-4805
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2022

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: 101YM0800X , with the licence number:  A-15436 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 567 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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