Provider Demographics
NPI:1790376655
Name:COPPOLA, LAURA CHRISTINE (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CHRISTINE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4353
Mailing Address - Country:US
Mailing Address - Phone:862-354-2678
Mailing Address - Fax:
Practice Address - Street 1:1198 GRACE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4353
Practice Address - Country:US
Practice Address - Phone:862-354-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011086131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical