Healthcare Provider Details

I. General information

NPI: 1770369464
Provider Name (Legal Business Name): LAURA ALDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 01/13/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEAD QUARTERS AND SERVICE BATTALION PSC BOX 20188
CAMP LEJUENE NC
28547
US

IV. Provider business mailing address

111 E 18TH ST APT 415
NORFOLK VA
23517-0020
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-5008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: