MEDICARE: MRS. LAURA LEE RUDISILL LCMHC-S

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	101YP2500X	Professional Counselor	3261	NC
2	101YP2500X	Professional Counselor	S3261	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1387Y	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861495319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA LEE RUDISILL LCMHC-S

Provider Business Mailing Address
First Line	:	1811 GREEN VALLEY DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28152-7639
Country	:	US
Telephone Number	:	704-482-2977
Fax Number	:	704-482-3501

Provider Business Practice Location Address
First Line	:	215 S WASHINGTON ST STE 104
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4675
Country	:	US
Telephone Number	:	704-482-2977
Fax Number	:	704-482-3501

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	09/09/2020

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