Provider Demographics
NPI:1306672241
Name:RAFFERTY, LILLIAN GRACE (LLMSW)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:GRACE
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-5836
Mailing Address - Country:US
Mailing Address - Phone:517-375-4740
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD # STWB110
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8445
Practice Address - Country:US
Practice Address - Phone:517-657-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851119023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health