Healthcare Provider Details

I. General information

NPI: 1083953004
Provider Name (Legal Business Name): LAURA T MOUNT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WESTLAKE RD STE. 1
FAYETTEVILLE NC
28314-4451
US

IV. Provider business mailing address

120 WESTLAKE RD SUITE 1
FAYETTEVILLE NC
28314-4451
US

V. Phone/Fax

Practice location:
  • Phone: 910-867-9754
  • Fax: 910-867-4600
Mailing address:
  • Phone: 910-273-9333
  • Fax: 910-867-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: