Provider Demographics
NPI:1750655262
Name:LORI ANN DRIVER LLC
Entity Type:Organization
Organization Name:LORI ANN DRIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-975-2757
Mailing Address - Street 1:3830 PACKARD ROAD SUITE 250
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2757
Mailing Address - Country:US
Mailing Address - Phone:734-975-2757
Mailing Address - Fax:734-975-2909
Practice Address - Street 1:3830 PACKARD ROAD SUITE 250
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2757
Practice Address - Country:US
Practice Address - Phone:734-975-2757
Practice Address - Fax:734-975-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010668841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty