Provider Demographics
NPI:1942757364
Name:GEORGE, SAMANTHA (LMSW,CAADC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LMSW,CAADC
Other - Prefix:
Other - First Name:SAMATHA
Other - Middle Name:
Other - Last Name:SEGNITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW,CAADC
Mailing Address - Street 1:2601 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6546
Mailing Address - Country:US
Mailing Address - Phone:810-987-9100
Mailing Address - Fax:
Practice Address - Street 1:2601 13TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6546
Practice Address - Country:US
Practice Address - Phone:810-987-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011156661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical