Healthcare Provider Details

I. General information

NPI: 1356743371
Provider Name (Legal Business Name): SAMANTHA ROSE DEHRING LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ROSE MCNAMARA LMSW, CAADC

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 313-364-0270
  • Fax: 800-991-2996
Mailing address:
  • Phone: 313-364-0270
  • Fax: 800-991-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-03159
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: