Healthcare Provider Details

I. General information

NPI: 1669106423
Provider Name (Legal Business Name): SAMANTHA CECIL, LMSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WASHTENAW AVE STE 282
ANN ARBOR MI
48104-5184
US

IV. Provider business mailing address

PO BOX 2265
ANN ARBOR MI
48106-2265
US

V. Phone/Fax

Practice location:
  • Phone: 734-623-9716
  • Fax:
Mailing address:
  • Phone: 734-623-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA JEAN CECIL
Title or Position: OWNER
Credential: LMSW
Phone: 734-623-9716