Healthcare Provider Details

I. General information

NPI: 1033007919
Provider Name (Legal Business Name): LAUREL FLOM LCMHCA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HAY ST
FAYETTEVILLE NC
28305-5312
US

IV. Provider business mailing address

806 HAY ST
FAYETTEVILLE NC
28305-5312
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-7008
  • Fax: 910-824-7593
Mailing address:
  • Phone: 910-860-7008
  • Fax: 910-824-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-30498
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21005
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: