Grooms, Samantha Marie
Grooms, Samantha Marie is an individual health care provider with primary practice located at 450 Saint John Rd Ste 501 , Michigan City IN 46360-7349. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Grooms, Samantha Marie can be contacted via phone (219) 879-0676.Contact Information
Primary practice address
450 Saint John Rd Ste 501
Michigan City IN 46360-7349
Phone: (219) 879-0676
Fax: (219) 873-9868
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 34006419A | Indiana |
Profile Details
| NPI number | 1760611354 |
|---|---|
| LBN Legal business name | Grooms, Samantha Marie |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 6th, 2009 |
| Last updated | Jan 19th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760611354 | NPPES |
| Indiana | MEDICAID | 100163580 |
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