Provider Demographics
NPI:1245759448
Name:LAURA JENNINGS, LMSW, PLLC
Entity Type:Organization
Organization Name:LAURA JENNINGS, LMSW, PLLC
Other - Org Name:AZALEA THERAPY AND CONSULTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-787-5872
Mailing Address - Street 1:7264 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3973
Mailing Address - Country:US
Mailing Address - Phone:734-787-5872
Mailing Address - Fax:
Practice Address - Street 1:7264 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2150
Practice Address - Country:US
Practice Address - Phone:734-787-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health