Provider Demographics
NPI:1801306055
Name:RAYMER, ELIZABETH DIANA (LMSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANA
Last Name:RAYMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DIANA
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 LAMBROS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3948
Mailing Address - Country:US
Mailing Address - Phone:989-430-0171
Mailing Address - Fax:
Practice Address - Street 1:218 FAST LANE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-430-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011140191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker