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Individual
LAURIE ANN LIDIE
Active
Individual
LAURIE ANN LIDIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
CSW89673
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134949B
—
GA
01
—
20280I5251
MEDICARE PTAN
GA
01
—
822720206
TAX ID
GA
Enumeration date
06/07/2013
Last updated
12/19/2024
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