Provider Demographics
NPI:1700184256
Name:LORING, CHARITY M (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:M
Last Name:LORING
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 1:24942 NOTRE DAME ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4495
Mailing Address - Country:US
Mailing Address - Phone:313-415-7622
Mailing Address - Fax:
Practice Address - Street 1:2240 MIDDLEBELT RD
Practice Address - Street 2:SUITE 212
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2892
Practice Address - Country:US
Practice Address - Phone:313-415-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010915141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical