Provider Demographics
NPI:1437408101
Name:LAFAVE, EMILY (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LAFAVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KOURNOIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:35300 NANKIN BLVD
Mailing Address - Street 2:601
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-261-1842
Mailing Address - Fax:
Practice Address - Street 1:35300 NANKIN BLVD STE 601
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7222
Practice Address - Country:US
Practice Address - Phone:734-261-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437408101Medicaid