Provider Demographics
NPI:1386318558
Name:LAURAIN, KATHERINE MARILYN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARILYN
Last Name:LAURAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2147
Mailing Address - Country:US
Mailing Address - Phone:734-625-4080
Mailing Address - Fax:
Practice Address - Street 1:2470 COLLINGWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1500
Practice Address - Country:US
Practice Address - Phone:313-437-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511035671041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool