Healthcare Provider Details

I. General information

NPI: 1184260143
Provider Name (Legal Business Name): LAUREN MARIE SEXTON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CHRYSLER SERVICE DRIVE STE. 3B
DETROIT MI
48201-2167
US

IV. Provider business mailing address

3901 CHRYSLER SERVICE DR. STE. 3B
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-1396
  • Fax: 313-577-1419
Mailing address:
  • Phone: 313-577-1396
  • Fax: 313-577-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801102812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: