Individual
LAURA LOUCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
12 EXECUTIVE PARK DR NE STE 300, ATLANTA, GA 30329-2206
(404) 712-9788
Mailing address
2656 PEELER RD, DUNWOODY, GA 30360-1904
(404) 712-9788
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY004189
GA
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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