Healthcare Provider Details

I. General information

NPI: 1134538663
Provider Name (Legal Business Name): LAURA KURDILA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 PETERS CREEK RD NW
ROANOKE VA
24017-2500
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-562-5700
  • Fax: 540-562-4278
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: