Provider Demographics
NPI:1033853569
Name:MATTINGLY, SAMANTHA ANN (BS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 DALLAS DR
Mailing Address - Street 2:
Mailing Address - City:GRANTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17028-9575
Mailing Address - Country:US
Mailing Address - Phone:703-973-9662
Mailing Address - Fax:
Practice Address - Street 1:3433 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4434
Practice Address - Country:US
Practice Address - Phone:717-761-4500
Practice Address - Fax:717-761-4554
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)