Healthcare Provider Details

I. General information

NPI: 1285031302
Provider Name (Legal Business Name): LAURA LONDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT JOHNSON LA
71459-5102
US

IV. Provider business mailing address

137 EAGLE POINT RD
LEESVILLE LA
71446-5041
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3011
  • Fax:
Mailing address:
  • Phone: 208-724-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13507
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: