Provider Demographics
NPI:1083848667
Name:MAXWELL, LAURIE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:WICKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2222 S LINDEN RD STE J
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5413
Mailing Address - Country:US
Mailing Address - Phone:810-732-0560
Mailing Address - Fax:810-732-6351
Practice Address - Street 1:70 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2033
Practice Address - Country:US
Practice Address - Phone:248-338-7458
Practice Address - Fax:248-338-7513
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor