Most Relevant Information
Provider Data
| NPI Number: | 1003578949 |
| Provider Name: | LAUREN ANN VAN LAETHEM MA, CBIS, CRC |
| Entity Type: | Individual |
| Taxonomy Code: | 225C00000X |
| Specialty: | Rehabilitation Counselor |
| License Number: | 324570 |
Most Important Dates
| Enumeration Date: | 10/07/2021 |
| Last Updated: | 10/07/2021 |
Provider Practice Location
11406 HERITAGE GREEN DR
CORNELIUS
NC
280317402
Practice Location Phone/Fax
| Phone: | 7047330111 |
| Fax: |
Provider Mailing Location
11406 HERITAGE GREEN DR
CORNELIUS
NC
280317402
Provider Mailing Phone/Fax
| Phone: | 7047330111 |
| Fax: |