Provider Demographics
NPI:1497006092
Name:RAY, LAURA (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1055 SOUTH BLVD E
Mailing Address - Street 2:#210
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5465
Mailing Address - Country:US
Mailing Address - Phone:248-656-0500
Mailing Address - Fax:248-656-0501
Practice Address - Street 1:1055 SOUTH BLVD E
Practice Address - Street 2:#210
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5465
Practice Address - Country:US
Practice Address - Phone:248-656-0500
Practice Address - Fax:248-656-0501
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010910381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical