Basic Information
| Provider Information | |||||||||
| NPI: | 1609247527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALCALA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LAC, LADC, MFT-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7785 SAINT GERTRUDE AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585644103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024850048 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7785 SAINT GERTRUDE AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585644103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015973419 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 01349 | NV | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 0667 | NV | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | 1888 | ND | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1888 | 01 | ND | STATE OF NORTH DAKOTA | OTHER |