Provider Demographics
NPI:1093229122
Name:SAMUEL, NADINE V (LPCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:V
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-7672
Mailing Address - Country:US
Mailing Address - Phone:910-817-7389
Mailing Address - Fax:
Practice Address - Street 1:196 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7672
Practice Address - Country:US
Practice Address - Phone:910-817-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health