Provider Demographics
NPI:1841571965
Name:SAMPSON, JAMES E (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 WATERFORD HILL TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3381
Mailing Address - Country:US
Mailing Address - Phone:586-202-6473
Mailing Address - Fax:
Practice Address - Street 1:6470 WATERFORD HILL TER
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3381
Practice Address - Country:US
Practice Address - Phone:586-202-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010846931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical