Provider Demographics
NPI:1770677460
Name:WINTERS, LAINA MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAINA
Middle Name:MICHELLE
Last Name:WINTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298528
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99629-8528
Mailing Address - Country:US
Mailing Address - Phone:907-354-8506
Mailing Address - Fax:
Practice Address - Street 1:1435 N. OLD TOWNE DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-1435
Practice Address - Country:US
Practice Address - Phone:907-354-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38561041C0700X
AK12321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical