Healthcare Provider Details

I. General information

NPI: 1174510903
Provider Name (Legal Business Name): MISS LAURA LEE TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MCLAWS CIR
WILLIAMSBURG VA
23185-5649
US

IV. Provider business mailing address

PO BOX 279
WILLIAMSBURG VA
23187-0279
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0111
  • Fax: 757-253-2884
Mailing address:
  • Phone: 757-253-0111
  • Fax: 757-253-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000043
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000681
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000161
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: