Healthcare Provider Details

I. General information

NPI: 1104436070
Provider Name (Legal Business Name): MRS. LAURIE MARIE ALDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 02/11/2022
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 MONTRIDGE CT
EL DORADO HILLS CA
95762-7238
US

IV. Provider business mailing address

PO BOX 4935
EL DORADO HILLS CA
95762-0026
US

V. Phone/Fax

Practice location:
  • Phone: 408-761-2961
  • Fax:
Mailing address:
  • Phone: 408-761-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: