Provider Demographics
NPI:1922157684
Name:BLACK, LAURA FRANCES (MSW, LMSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:FRANCES
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 N DENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1124
Mailing Address - Country:US
Mailing Address - Phone:313-563-9826
Mailing Address - Fax:
Practice Address - Street 1:15000 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1973
Practice Address - Country:US
Practice Address - Phone:313-245-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker