Provider Demographics
NPI:1508541855
Name:RHOADES, SAMUEL I (LMSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:I
Last Name:RHOADES
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 1:1646 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8441
Mailing Address - Country:US
Mailing Address - Phone:806-445-4639
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 115
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0437
Practice Address - Country:US
Practice Address - Phone:517-394-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011186781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical