Provider Demographics
NPI:1447870423
Name:SAMUELS, SAMANTHA O (BS,CPS)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:O
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:BS,CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WATERFORD LNDG
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7709
Mailing Address - Country:US
Mailing Address - Phone:404-661-0400
Mailing Address - Fax:
Practice Address - Street 1:313 WATERFORD LNDG
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7709
Practice Address - Country:US
Practice Address - Phone:404-661-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty