Healthcare Provider Details

I. General information

NPI: 1972425288
Provider Name (Legal Business Name): SAMUEL JOSEPH LAURENT LCMHCA, PHD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 FORDHAM BLVD STE 204
CHAPEL HILL NC
27514-5885
US

IV. Provider business mailing address

1777 FORDHAM BLVD STE 204
CHAPEL HILL NC
27514-5885
US

V. Phone/Fax

Practice location:
  • Phone: 919-275-2137
  • Fax:
Mailing address:
  • Phone: 919-275-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23300
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: