Healthcare Provider Details

I. General information

NPI: 1669122586
Provider Name (Legal Business Name): LAURA HAIN ROYSTER LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHARON RD W
CHARLOTTE NC
28210-5663
US

IV. Provider business mailing address

1717 SHARON RD W
CHARLOTTE NC
28210-5663
US

V. Phone/Fax

Practice location:
  • Phone: 980-589-0990
  • Fax:
Mailing address:
  • Phone: 980-859-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020381
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: