Provider Demographics
NPI:1962082636
Name:L
Entity type:Organization
Organization Name:L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-LAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-813-0863
Mailing Address - Street 1:220 W SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4661
Mailing Address - Country:US
Mailing Address - Phone:717-813-0863
Mailing Address - Fax:586-752-2739
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4621
Practice Address - Country:US
Practice Address - Phone:717-813-0863
Practice Address - Fax:586-752-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health