Provider Demographics
NPI:1831129832
Name:KIMMEL, LAURIE B (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:B
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4515
Mailing Address - Country:US
Mailing Address - Phone:248-626-1500
Mailing Address - Fax:248-626-1551
Practice Address - Street 1:6960 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4515
Practice Address - Country:US
Practice Address - Phone:248-626-1500
Practice Address - Fax:248-526-1551
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801057192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker