Provider Demographics
NPI:1518539535
Name:LAROSE, MARIE CHRISTINE (MSW, DP-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CHRISTINE
Last Name:LAROSE
Suffix:
Gender:F
Credentials:MSW, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1210
Mailing Address - Country:US
Mailing Address - Phone:248-573-7417
Mailing Address - Fax:
Practice Address - Street 1:127 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1210
Practice Address - Country:US
Practice Address - Phone:248-573-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA