Provider Demographics
NPI:1114545522
Name:REINIER, SAMANTHA (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:REINIER
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 BRUNSWICK AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1891
Mailing Address - Country:US
Mailing Address - Phone:704-559-9605
Mailing Address - Fax:
Practice Address - Street 1:1914 BRUNSWICK AVE STE 1B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1891
Practice Address - Country:US
Practice Address - Phone:704-910-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0159681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician