Provider Demographics
NPI:1912882192
Name:VAN ATTA, SAMANTHA KALEI
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:KALEI
Last Name:VAN ATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14886 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3217
Mailing Address - Country:US
Mailing Address - Phone:910-795-7119
Mailing Address - Fax:
Practice Address - Street 1:14886 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3217
Practice Address - Country:US
Practice Address - Phone:910-795-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician