Provider Demographics
NPI:1780353193
Name:CLARKSTON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CLARKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7836 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-7805
Mailing Address - Country:US
Mailing Address - Phone:586-292-3435
Mailing Address - Fax:
Practice Address - Street 1:127 E NEWBERRY ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4769
Practice Address - Country:US
Practice Address - Phone:586-281-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker