Provider Demographics
NPI:1235939414
Name:COLEY, SAMOAN
Entity type:Individual
Prefix:
First Name:SAMOAN
Middle Name:
Last Name:COLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 POST CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3874
Mailing Address - Country:US
Mailing Address - Phone:919-394-5404
Mailing Address - Fax:
Practice Address - Street 1:1706 POST CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3874
Practice Address - Country:US
Practice Address - Phone:919-394-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician