Individual
MS. BEVERLY JEAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
20600 EUREKA ROAD, SUITE 819, TAYLOR, MI 48180
(734) 285-8282
(734) 281-0402
Mailing address
5493 GREENWAY DRIVE, TRENTON, MI 48183-7207
(734) 692-0382
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801011987
MI
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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