Healthcare Provider Details

I. General information

NPI: 1609247527
Provider Name (Legal Business Name): LAURA JEAN ALCALA LAC, LADC, MFT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 SAINT GERTRUDE AVE
RALEIGH ND
58564-4103
US

IV. Provider business mailing address

7785 SAINT GERTRUDE AVE
RALEIGH ND
58564-4103
US

V. Phone/Fax

Practice location:
  • Phone: 701-597-3419
  • Fax:
Mailing address:
  • Phone: 702-485-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01349
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0667
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1888
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: