Basic Information
| Provider Information | |||||||||
| NPI: | 1871661082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERLAIN-CLEMENTS | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | DANENE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW ACSW, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3076 E MONROE RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486427249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898392894 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2603 W WACKERLY ST | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486406903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896312320 | ||||||||
| FaxNumber: | 9896319903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801017305 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.