Provider Demographics
NPI:1598007361
Name:EBURNE, SAMANTHA ANNE (MSW, LLMSE)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ANNE
Last Name:EBURNE
Suffix:
Gender:F
Credentials:MSW, LLMSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 N. WAYNE ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-425-0636
Mailing Address - Fax:734-425-4771
Practice Address - Street 1:8523 NORTH WAYNE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-425-0636
Practice Address - Fax:734-425-4771
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010952011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical