Basic Information
| Provider Information | |||||||||
| NPI: | 1073978524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUTURE | ||||||||
| FirstName: | LYDIA | ||||||||
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| Credential: | B.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 APPLEWOOD | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 ENTERPRISE PATH | ||||||||
| Address2: | |||||||||
| City: | HIRAM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785679020 | ||||||||
| FaxNumber: | 6785679050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2015 | ||||||||
| LastUpdateDate: | 12/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.