Provider Demographics
NPI:1306919717
Name:SAM, JAMES MICHAEL (PHD LMSW)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:SAM
Suffix:
Gender:M
Credentials:PHD LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4016
Mailing Address - Country:US
Mailing Address - Phone:810-794-7574
Mailing Address - Fax:810-794-7574
Practice Address - Street 1:1209 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3548
Practice Address - Country:US
Practice Address - Phone:810-984-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000060101YP2500X
MI6301009063103TC0700X
MI68010329151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical