Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 103TF0200X | Forensic Psychologist | 6301018346 | MI |
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1588972483 |
---|---|
Provider Name | Samarea Lenore |
First Address | Flint, MI 48532-3604 |
Second Address | Flint, MI 48532-3604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 01/06/2020 |