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NPI Code Detail

MEDICARE: MRS. LAURA L. TRUESDALE LISW-CP

MEDICARE: MRS. LAURA L. TRUESDALE LISW-CP
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
11041C0700XClinical Social Worker006387SC

General Provider Information

NPI Number : 1609951953
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA L. TRUESDALE LISW-CP
Provider Business Mailing Address
First Line : 1316 N LAKE DR
Second Line : ADOLESCENT RECOVERY CENTER
City : LEXINGTON
State : SC
Zip : 29072-7653
Country : US
Telephone Number : 803-951-1940
Fax Number : 803-951-1963
Provider Business Practice Location Address
First Line : 1316 N LAKE DR
Second Line : ADOLESCENT RECOVERY CENTER
City : LEXINGTON
State : SC
Zip : 29072-7653
Country : US
Telephone Number : 803-951-1940
Fax Number : 803-951-1963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA L. TRUESDALE LISW-CP” Practice Location

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