Provider Demographics
NPI:1538382098
Name:SMITH MORELOCK, LAURA (MSW LISW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SMITH MORELOCK
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SMITH MORELOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:3000 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1420
Mailing Address - Country:US
Mailing Address - Phone:937-671-0862
Mailing Address - Fax:
Practice Address - Street 1:2218 SOUTH PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1959
Practice Address - Country:US
Practice Address - Phone:937-299-1918
Practice Address - Fax:937-299-4832
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI94641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6615920OtherUNITED HEALTH CARE
OH000000975072OtherANTHEM BLUE CROSS BLUE SHIELD
OH562176000OtherMAGELLAN
11634750OtherCAQH