Healthcare Provider Details

I. General information

NPI: 1497132773
Provider Name (Legal Business Name): LAURA HANCOCK MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LATROBE DR STE B
CHARLOTTE NC
28211-5227
US

IV. Provider business mailing address

9014 ROSETON LN
CHARLOTTE NC
28277-2240
US

V. Phone/Fax

Practice location:
  • Phone: 704-780-4271
  • Fax: 888-261-6694
Mailing address:
  • Phone: 704-460-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09538
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: