Provider Demographics
NPI:1043991177
Name:SCHEUSSLER, SAMANTHA LOVE-FONG (APCC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LOVE-FONG
Last Name:SCHEUSSLER
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 BEATTY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2380
Mailing Address - Country:US
Mailing Address - Phone:951-990-2278
Mailing Address - Fax:
Practice Address - Street 1:801 SUTTER ST APT 305
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6107
Practice Address - Country:US
Practice Address - Phone:951-990-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional