Healthcare Provider Details

I. General information

NPI: 1518879899
Provider Name (Legal Business Name): SAMANTHA LOFTUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24062 TAFT RD
NOVI MI
48375-3022
US

IV. Provider business mailing address

9215 MABLEY HILL RD
FENTON MI
48430-9465
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851110604
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: