Basic Information
| Provider Information | |||||||||
| NPI: | 1962775635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUBE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MSW, P-LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 S MAIN ST | ||||||||
| Address2: | A | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272155756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364374991 | ||||||||
| FaxNumber: | 3362295906 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 S MAIN ST | ||||||||
| Address2: | A | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272155756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364374991 | ||||||||
| FaxNumber: | 3362295906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2012 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P006493 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.