Provider Demographics
NPI:1376536367
Name:SAMONS, SANDRA LEA (PHD, MSW)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEA
Last Name:SAMONS
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 SHEVCHENKO DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9001
Mailing Address - Country:US
Mailing Address - Phone:734-663-7871
Mailing Address - Fax:
Practice Address - Street 1:1480 SHEVCHENKO DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9001
Practice Address - Country:US
Practice Address - Phone:734-663-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00035101YA0400X
MIGENDER IDENTITY SPEC104100000X
MI68101035791041C0700X
MI4101005512106H00000X
MI6801013579104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8499OtherMI ASSC OF A/DA COUNSELOR
MI4101005512OtherLMFT
MI2-00035OtherMI CERT. BOARD FOR ADDIC
MI6801013579OtherREGISTERED CERTIFIED S. W
MI8499OtherMI ASSC OF A/DA COUNSELOR