Provider Demographics
NPI:1902643414
Name:OLIVER, SAMANTHA MARIE (LLMSW, QIDP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LLMSW, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-1628
Mailing Address - Country:US
Mailing Address - Phone:810-964-3029
Mailing Address - Fax:
Practice Address - Street 1:5095 VAN SLYKE RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3959
Practice Address - Country:US
Practice Address - Phone:810-931-4981
Practice Address - Fax:810-767-5070
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
MI68511190851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6851119085OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS