Healthcare Provider Details

I. General information

NPI: 1952855157
Provider Name (Legal Business Name): SAMANTHA MCCULLOUGH LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6295 N ELMS RD
FLUSHING MI
48433-9002
US

IV. Provider business mailing address

2169 W VIENNA RD STE 162
CLIO MI
48420-1757
US

V. Phone/Fax

Practice location:
  • Phone: 810-243-2660
  • Fax: 810-309-8833
Mailing address:
  • Phone: 810-243-2660
  • Fax: 810-309-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106597
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: