Provider Demographics
NPI:1548826449
Name:THELEN, SAMANTHA LEIGH (LMSW, CAADC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:THELEN
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LEIGH
Other - Last Name:KEMPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:622 E GRAND RIVER
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-548-0081
Mailing Address - Fax:517-548-0498
Practice Address - Street 1:575 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1778
Practice Address - Country:US
Practice Address - Phone:734-451-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty