Provider Demographics
NPI:1538477138
Name:MUSSELWHITE, LAURA DOUGLAS (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DOUGLAS
Last Name:MUSSELWHITE
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 ANDREWS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2993
Mailing Address - Country:US
Mailing Address - Phone:919-682-5777
Mailing Address - Fax:919-687-6975
Practice Address - Street 1:411 ANDREWS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2993
Practice Address - Country:US
Practice Address - Phone:919-682-5777
Practice Address - Fax:919-687-6975
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041681041C0700X
NC1612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002461Medicaid