Provider Demographics
NPI:1477896777
Name:HEWSON, LARA (MSW, LMSW, IMH-E III)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:HEWSON
Suffix:
Gender:F
Credentials:MSW, LMSW, IMH-E III
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1206 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2005
Mailing Address - Country:US
Mailing Address - Phone:517-783-4250
Mailing Address - Fax:517-783-4164
Practice Address - Street 1:1206 CLINTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2005
Practice Address - Country:US
Practice Address - Phone:517-783-4250
Practice Address - Fax:517-783-4164
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010932311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical