Provider Demographics
NPI:1023303476
Name:FAWZY, LAURA CRUZ (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CRUZ
Last Name:FAWZY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LGPC
Mailing Address - Street 1:1215 INGRAHAM ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3601
Mailing Address - Country:US
Mailing Address - Phone:904-219-0421
Mailing Address - Fax:
Practice Address - Street 1:610 E DIAMOND AVE STE 100A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5321
Practice Address - Country:US
Practice Address - Phone:301-840-3200
Practice Address - Fax:301-840-1348
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7068101YP2500X
MDLC9361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional