Healthcare Provider Details

I. General information

NPI: 1982928479
Provider Name (Legal Business Name): LAURA ANNE YATES MSW, LCSW, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 RAEFORD RD STE 2
FAYETTEVILLE NC
28305-5086
US

IV. Provider business mailing address

226 KING MILL RD
FOUR OAKS NC
27524-8364
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-6336
  • Fax:
Mailing address:
  • Phone: 919-523-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: