Provider Demographics
NPI:1861790503
Name:DAVIE, LAURA JACOBS (LMSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JACOBS
Last Name:DAVIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6184
Mailing Address - Country:US
Mailing Address - Phone:734-436-4236
Mailing Address - Fax:
Practice Address - Street 1:2245 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6184
Practice Address - Country:US
Practice Address - Phone:734-436-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health