Provider Demographics
NPI:1164845186
Name:SAMSON, CHANTAL (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:CHANTAL
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 N ROXBORO ST
Mailing Address - Street 2:APT. 2C
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2740
Mailing Address - Country:US
Mailing Address - Phone:301-648-0120
Mailing Address - Fax:
Practice Address - Street 1:3523 N ROXBORO ST
Practice Address - Street 2:APT. 2C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2740
Practice Address - Country:US
Practice Address - Phone:301-648-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0078341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical