Healthcare Provider Details

I. General information

NPI: 1346077724
Provider Name (Legal Business Name): SAMANTHA MARIE BURNETT LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 JOLLY OAK RD
OKEMOS MI
48864-3546
US

IV. Provider business mailing address

26545 AMERICAN DR
SOUTHFIELD MI
48034-6115
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax:
Mailing address:
  • Phone: 800-395-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118529
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: