Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 324570 | NC |
NPI | 1003578949 |
---|---|
Provider Name | Lauren Ann Van Laethem |
First Address | Cornelius, NC 28031-7402 |
Second Address | Cornelius, NC 28031-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 07/10/2021 |