Healthcare Provider Details

I. General information

NPI: 1215493549
Provider Name (Legal Business Name): SAMMIE EDWARDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15734 SUSSEX ST
DETROIT MI
48227-2659
US

IV. Provider business mailing address

15734 SUSSEX ST
DETROIT MI
48227-2659
US

V. Phone/Fax

Practice location:
  • Phone: 313-807-0648
  • Fax:
Mailing address:
  • Phone: 313-807-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: