Provider Demographics
NPI:1184001299
Name:VANHARMELEN, LORI LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:VANHARMELEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:HAVEN
Other - Last Name:COUNSELING, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4565 WILSON AVE SW STE 4A
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2371
Mailing Address - Country:US
Mailing Address - Phone:616-780-0402
Mailing Address - Fax:
Practice Address - Street 1:4565 WILSON AVE SW STE 4A
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2371
Practice Address - Country:US
Practice Address - Phone:616-780-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical