Provider Demographics
NPI:1356743371
Name:DEHRING, SAMANTHA ROSE (LMSW, CAADC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ROSE
Last Name:DEHRING
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:ROSE
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:625 KENMOOR AVE SE STE 301
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:313-364-0270
Mailing Address - Fax:800-991-2996
Practice Address - Street 1:625 KENMOOR AVE SE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2395
Practice Address - Country:US
Practice Address - Phone:313-364-0270
Practice Address - Fax:800-991-2996
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03159101YA0400X
MI68010968201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801096820OtherMASTERS SOCIAL WORK LICENSE