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General NPI Number Information
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NPI Number | 1164285235
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Entity Type | Individual
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Provider Name | SAMANTHA GIANNOSA LLC
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Gender | Female
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2601 13TH ST
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City | PORT HURON
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State | MI
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Zip | 48060-6546
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Country | US
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Telephone | 810-987-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 13TH ST
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City | PORT HURON
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State | MI
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Zip | 48060-6546
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Country | US
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Telephone | 810-987-9100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451024032
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License Number State | MI
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