Healthcare Provider Details

I. General information

NPI: 1700776796
Provider Name (Legal Business Name): SAMANTHA MCNEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 CASCADE RD SE STE 100
GRAND RAPIDS MI
49546-2135
US

IV. Provider business mailing address

241 FINNEY AVE SW STE 1
GRAND RAPIDS MI
49503-4311
US

V. Phone/Fax

Practice location:
  • Phone: 616-319-1978
  • Fax:
Mailing address:
  • Phone: 616-375-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: