Provider Information for 1629293261
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Mrs. SAMANTHA D'ESTI EISENHART-PETKOVSKI LMHC, LPC
Sex: Female
NPI: 1629293261
Last Updated: 2025-02-18
Certification Date: 2025-02-18
Certification Date: 2025-02-18
Details
| Name | Value | ||||||||||||||||
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| NPI | 1629293261 | ||||||||||||||||
| Enumeration Date | 2007-04-17 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 204 EAGLE CT BEDFORD, TX 76021-3216 United States Phone: 972-895-2326 | Fax:866-627-3513 | ||||||||||||||||
| Primary Practice Address | 60657 S LYON TRL SOUTH LYON, MI 48178-9054 United States Phone: 321-356-0146 | Fax: | ||||||||||||||||
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