Provider Demographics
NPI:1720538358
Name:FOX, LAURA ROSE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSE
Last Name:FOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:SWIDERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:800 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1308
Mailing Address - Country:US
Mailing Address - Phone:517-230-1959
Mailing Address - Fax:
Practice Address - Street 1:800 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1308
Practice Address - Country:US
Practice Address - Phone:517-230-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical