Healthcare Provider Details

I. General information

NPI: 1780353193
Provider Name (Legal Business Name): LAURA CLARKSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E NEWBERRY ST
ROMEO MI
48065-4769
US

IV. Provider business mailing address

7836 YORKSHIRE DR
ALMONT MI
48003-7805
US

V. Phone/Fax

Practice location:
  • Phone: 586-281-3512
  • Fax:
Mailing address:
  • Phone: 586-292-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121730
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: