MEDICARE: SAMANTHA ABDULLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		MI

General Provider Information

NPI Number	:	1558808246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ABDULLA

Provider Business Mailing Address
First Line	:	1420 HANOVER AVE APT 3F
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-6237
Country	:	US
Telephone Number	:	313-740-0774
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-2816
Country	:	US
Telephone Number	:	313-922-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	06/26/2024

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Directions to “ SAMANTHA ABDULLA ” Practice Location

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