Provider Demographics
NPI:1093826455
Name:SAMPSON, AYANNA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:S
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:195 SE VICTORIA GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-9307
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-6386
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:PSY-116-A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:386-754-6386
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006831104100000X
GACSW0050011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker