Healthcare Provider Details

I. General information

NPI: 1952452039
Provider Name (Legal Business Name): LAURA A SEITZ LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 ORCHARD LAKE DR UNIT C
CHARLOTTE NC
28270-1475
US

IV. Provider business mailing address

1421 ORCHARD LAKE DR UNIT C
CHARLOTTE NC
28270-1475
US

V. Phone/Fax

Practice location:
  • Phone: 704-844-0181
  • Fax:
Mailing address:
  • Phone: 704-844-0181
  • Fax: 904-701-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006395
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: