MEDICARE: MRS. LAURIE A BAJALIA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT000981	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083622468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE A BAJALIA LMFT

Provider Business Mailing Address
First Line	:	1803 CANTERBURY DR STE C
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-0505
Country	:	US
Telephone Number	:	229-588-4051
Fax Number	:	229-588-4051

Provider Business Practice Location Address
First Line	:	1803 CANTERBURY DR STE C
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-0505
Country	:	US
Telephone Number	:	229-588-4051
Fax Number	:	229-588-4051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/04/2024

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