Provider Demographics
NPI:1114949427
Name:SAMPSON, CAROL B (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:B
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHINN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4311
Mailing Address - Country:US
Mailing Address - Phone:707-579-0239
Mailing Address - Fax:707-579-0240
Practice Address - Street 1:405 CHINN ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4311
Practice Address - Country:US
Practice Address - Phone:707-579-0239
Practice Address - Fax:707-579-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist