Provider Demographics
NPI:1679390116
Name:WATERS, LAUREN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:WATERS
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 1:1605 E 13 MILE RD APT 108
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5018
Mailing Address - Country:US
Mailing Address - Phone:586-944-5757
Mailing Address - Fax:
Practice Address - Street 1:1605 E 13 MILE RD APT 108
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5018
Practice Address - Country:US
Practice Address - Phone:586-944-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011181011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical