Provider Demographics
NPI:1407409709
Name:LARGE, LAURA ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:LARGE
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:COUSELING ASSOCIATES, INC.
Mailing Address - Street 2:6960 ORCHARD LAKE RD. STE. 100
Mailing Address - City:W. BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-626-1500
Mailing Address - Fax:248-626-1551
Practice Address - Street 1:COUSELING ASSOCIATES, INC.
Practice Address - Street 2:6960 ORCHARD LAKE RD. STE. 100
Practice Address - City:W. BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-626-1500
Practice Address - Fax:248-626-1551
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010461441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical