Provider Demographics
NPI:1922269406
Name:PERCIVAL OATES, LAURIE MARGARET (MA)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:MARGARET
Last Name:PERCIVAL OATES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:MARGARET
Other - Last Name:OATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-0004
Mailing Address - Country:US
Mailing Address - Phone:828-265-0102
Mailing Address - Fax:828-297-4995
Practice Address - Street 1:577 GEORGE WILSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8612
Practice Address - Country:US
Practice Address - Phone:828-265-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCLPC2728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health