Provider Demographics
NPI:1679014872
Name:MCLAURINE, ROESLAID RENE (LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:ROESLAID
Middle Name:RENE
Last Name:MCLAURINE
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39160 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5717
Mailing Address - Country:US
Mailing Address - Phone:248-602-6003
Mailing Address - Fax:844-829-4484
Practice Address - Street 1:26677 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1514
Practice Address - Country:US
Practice Address - Phone:248-602-6003
Practice Address - Fax:844-829-4484
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230357211041C0700X
MI68010983051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679014872Medicaid