Individual
LAURA JANET ELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LCP
Contact information
Practice address
1402 GRANDIN RD SW STE 211, ROANOKE, VA 24015-2348
(540) 655-2751
Mailing address
3400 KIM CT APT A15, ROANOKE, VA 24018-5090
(662) 801-3359
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004782
VA
Other
Enumeration date
01/22/2008
Last updated
04/09/2018
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