Provider Demographics
NPI:1700205937
Name:LOUIS, LAURA (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 PEACHTREE ST NE APT 1420
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1237
Mailing Address - Country:US
Mailing Address - Phone:404-496-8070
Mailing Address - Fax:
Practice Address - Street 1:1758 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3714
Practice Address - Country:US
Practice Address - Phone:404-496-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist