Basic Information
| Provider Information | |||||||||
| NPI: | 1497132773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANCOCK | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9014 ROSETON LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282772240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044600459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 LATROBE DR STE B | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282115227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047804271 | ||||||||
| FaxNumber: | 8882616694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2015 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | 09538 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | 103K00000X | NC | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | NC | N |
No ID Information.