Provider Demographics
NPI:1134704141
Name:HATCH, LAURA SUSAN-STROM (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUSAN-STROM
Last Name:HATCH
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 1:22180 QUAIL RUN CIR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1600
Mailing Address - Country:US
Mailing Address - Phone:248-444-9646
Mailing Address - Fax:
Practice Address - Street 1:22180 QUAIL RUN CIR UNIT 3
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1600
Practice Address - Country:US
Practice Address - Phone:248-444-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801021102104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker