Provider Demographics
NPI:1558968255
Name:LOOMAN, LAURA NICOLE MARCUS (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE MARCUS
Last Name:LOOMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 SUMMER CREEK CT SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7515
Mailing Address - Country:US
Mailing Address - Phone:616-481-4645
Mailing Address - Fax:
Practice Address - Street 1:5020 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6869
Practice Address - Country:US
Practice Address - Phone:616-439-1866
Practice Address - Fax:616-226-4603
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011173461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical