Provider Demographics
NPI:1215493549
Name:EDWARDS, SAMMIE (LPC)
Entity type:Individual
Prefix:
First Name:SAMMIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23161 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2495
Mailing Address - Country:US
Mailing Address - Phone:313-658-7300
Mailing Address - Fax:
Practice Address - Street 1:24724 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6011
Practice Address - Country:US
Practice Address - Phone:313-658-7300
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017583101YP2500X
6401011882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790247930Medicaid