Provider Demographics
NPI:1770909145
Name:SAMARITAN COUNSELING SERVICES
Entity type:Organization
Organization Name:SAMARITAN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:PREPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:734-677-0609
Mailing Address - Street 1:2890 CARPENTER RD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1100
Mailing Address - Country:US
Mailing Address - Phone:734-677-0609
Mailing Address - Fax:734-677-3072
Practice Address - Street 1:2890 CARPENTER RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1100
Practice Address - Country:US
Practice Address - Phone:734-677-0609
Practice Address - Fax:734-677-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty