Healthcare Provider Details

I. General information

NPI: 1831928597
Provider Name (Legal Business Name): LAUREN NICOLE COOPER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NICOLE DOMBROWSKI LMSW

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

IV. Provider business mailing address

24799 BRIAR BAY DR
MACOMB MI
48042-5537
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax: 248-625-6829
Mailing address:
  • Phone: 586-567-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: