Provider Demographics
NPI:1578986022
Name:REA, LAURA (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10854 M 32 E
Mailing Address - Street 2:
Mailing Address - City:JOHANNESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49751-9622
Mailing Address - Country:US
Mailing Address - Phone:989-785-5986
Mailing Address - Fax:989-358-7835
Practice Address - Street 1:10854 M 32 E
Practice Address - Street 2:
Practice Address - City:JOHANNESBURG
Practice Address - State:MI
Practice Address - Zip Code:49751-9622
Practice Address - Country:US
Practice Address - Phone:989-785-5986
Practice Address - Fax:989-358-7835
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health