Healthcare Provider Details

I. General information

NPI: 1538108030
Provider Name (Legal Business Name): LAURA PURVIS BARRETT M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 SARDIS RD N SUITE 207
CHARLOTTE NC
28270-1426
US

IV. Provider business mailing address

1811 SARDIS RD N SUITE 207
CHARLOTTE NC
28270-1426
US

V. Phone/Fax

Practice location:
  • Phone: 704-708-6538
  • Fax: 704-573-4560
Mailing address:
  • Phone: 704-708-6538
  • Fax: 704-573-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: