Provider Demographics
NPI:1578457586
Name:GHARIOS, LAURA RITA-THERESE
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:RITA-THERESE
Last Name:GHARIOS
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 1:5838 4TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3627
Mailing Address - Country:US
Mailing Address - Phone:313-938-9134
Mailing Address - Fax:
Practice Address - Street 1:21751 W 11 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3779
Practice Address - Country:US
Practice Address - Phone:810-207-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851120036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker