Provider Demographics
NPI:1689405201
Name:GOLDSTEIN, LAURA GARGALA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GARGALA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ASHLEY
Other - Last Name:GARGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 COLONIAL PARK DR STE AND400
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8404
Mailing Address - Country:US
Mailing Address - Phone:678-856-5042
Mailing Address - Fax:
Practice Address - Street 1:555 COLONIAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8404
Practice Address - Country:US
Practice Address - Phone:678-856-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker