Provider Demographics
NPI:1871019521
Name:PUGSLEY, LAURA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:PUGSLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SLOAN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4922
Mailing Address - Country:US
Mailing Address - Phone:770-594-3066
Mailing Address - Fax:770-594-3099
Practice Address - Street 1:114 SLOAN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4922
Practice Address - Country:US
Practice Address - Phone:770-594-3066
Practice Address - Fax:770-594-3066
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional