Provider Demographics
NPI:1730952938
Name:WILLEMIN, LAURA SUSAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUSAN
Last Name:WILLEMIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 LITTLE PATUXENT PKWY APT 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4336
Mailing Address - Country:US
Mailing Address - Phone:410-707-5463
Mailing Address - Fax:
Practice Address - Street 1:8990 OLD ANNAPOLIS RD # A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2182
Practice Address - Country:US
Practice Address - Phone:443-367-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical