Provider Demographics
NPI:1255990222
Name:LAWLOR-CLARK, LAURIE DENISE (CPS, MSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:DENISE
Last Name:LAWLOR-CLARK
Suffix:
Gender:F
Credentials:CPS, MSW
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:DENISE
Other - Last Name:LAWLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4372 MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8689
Mailing Address - Country:US
Mailing Address - Phone:810-449-7660
Mailing Address - Fax:
Practice Address - Street 1:1110 ELDON BAKER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1923
Practice Address - Country:US
Practice Address - Phone:810-449-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI6801104948104100000X
MI68011123271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker