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General NPI Number Information
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NPI Number | 1366918013
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Entity Type | Individual
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Provider Name | LAURA MARIE HAVEY LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/21/2018
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Last Update Date | 10/21/2018
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Provider Practice Location Address
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Address Line | 6504 28TH ST SE STE Q1
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6959
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Country | US
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Telephone | 616-389-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 100 ROLLINGBROOK NE
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City | ADA
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State | MI
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Zip | 49301-9015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801088498
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License Number State | MI
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