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General NPI Number Information
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NPI Number | 1588292601
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Entity Type | Organization
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Legal Business Name | SAMARITAS
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 923 S BEECHTREE ST STE 10
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2306
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Country | US
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Telephone | 616-516-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 923 S BEECHTREE ST STE 10
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2306
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Country | US
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Telephone | 616-516-9985
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Fax |
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Authorized Official
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Title or Position | VP OF QUALITY
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Name | ABIGAIL A PERRY
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Credential | MA, SST
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Telephone | 313-410-7438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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