Healthcare Provider Details

I. General information

NPI: 1760127559
Provider Name (Legal Business Name): LAUREL HARDING MS, PLSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREL GROVE

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WINCHESTER AVE
MARTINSBURG WV
25401-1650
US

IV. Provider business mailing address

72 BUGLE LN
KEARNEYSVILLE WV
25430-4754
US

V. Phone/Fax

Practice location:
  • Phone: 304-886-4118
  • Fax:
Mailing address:
  • Phone: 304-839-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPL082115998
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: