Healthcare Provider Details

I. General information

NPI: 1295619708
Provider Name (Legal Business Name): SAMAR ABBASI LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W STADIUM BLVD STE 1
ANN ARBOR MI
48103-7008
US

IV. Provider business mailing address

6953 CRESTWOOD ST
DEARBORN HEIGHTS MI
48127-1917
US

V. Phone/Fax

Practice location:
  • Phone: 734-904-1078
  • Fax:
Mailing address:
  • Phone: 133-694-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023161
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number316280
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: