Provider Demographics
NPI:1598147076
Name:FERENTINE, LAURA (BS,LBSW,QIDP,QMHP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FERENTINE
Suffix:
Gender:F
Credentials:BS,LBSW,QIDP,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32229 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4302
Mailing Address - Country:US
Mailing Address - Phone:734-261-7530
Mailing Address - Fax:734-261-4192
Practice Address - Street 1:32229 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4302
Practice Address - Country:US
Practice Address - Phone:734-261-7530
Practice Address - Fax:734-261-4192
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802078264104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker