Provider Demographics
NPI:1255503090
Name:PROCTOR, LORRI ANN (LMSW CSW)
Entity Type:Individual
Prefix:MS
First Name:LORRI
Middle Name:ANN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LMSW CSW
Other - Prefix:MS
Other - First Name:LORRI
Other - Middle Name:ANN
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW CSW
Mailing Address - Street 1:43039 WINDING POND TRL
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-7206
Mailing Address - Country:US
Mailing Address - Phone:734-765-7684
Mailing Address - Fax:
Practice Address - Street 1:43039 WINDING POND TRL
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-7206
Practice Address - Country:US
Practice Address - Phone:734-765-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010654931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical