Provider Demographics
NPI:1821450404
Name:CHILCOTE RITENBURGH, SAMANTHA (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CHILCOTE RITENBURGH
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CHILCOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, TLLP
Mailing Address - Street 1:2730 S PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2730 S PATTERSON RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348
Practice Address - Country:US
Practice Address - Phone:616-902-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016516103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling