Healthcare Provider Details

I. General information

NPI: 1366918013
Provider Name (Legal Business Name): LAURA MARIE HAVEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2018
Last Update Date: 10/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 28TH ST SE STE Q1
GRAND RAPIDS MI
49546-6959
US

IV. Provider business mailing address

100 ROLLINGBROOK NE
ADA MI
49301-9015
US

V. Phone/Fax

Practice location:
  • Phone: 616-389-5301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088498
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: