MEDICARE: LAUREN DELANEY VANDEMORE MS, CRC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A15001	NC
2	101Y00000X	Counselor	15001	NC

General Provider Information

NPI Number	:	1629621735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DELANEY VANDEMORE MS, CRC

Provider Business Mailing Address
First Line	:	325 E PARK AVE APT 2
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4770
Country	:	US
Telephone Number	:	704-771-4639
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:	980-217-6901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	12/31/2021

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