Provider Demographics
NPI:1114436177
Name:WILLIAMS, LAURA LORAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LORAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2618
Mailing Address - Country:US
Mailing Address - Phone:248-693-9635
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2100
Practice Address - Country:US
Practice Address - Phone:248-229-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801073440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker