Healthcare Provider Details

I. General information

NPI: 1083564124
Provider Name (Legal Business Name): LAURA HENDERSON WRIGHT LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S MAIN ST STE 202
DAVIDSON NC
28036-8039
US

IV. Provider business mailing address

10225 RIVENDELL LN
CHARLOTTE NC
28269-7009
US

V. Phone/Fax

Practice location:
  • Phone: 540-293-2584
  • Fax:
Mailing address:
  • Phone: 540-293-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22526
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: