Provider Demographics
NPI:1194462861
Name:SAMPLER, JAYME
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:SAMPLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 TERRACE LN APT 3101
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5403
Mailing Address - Country:US
Mailing Address - Phone:931-981-3814
Mailing Address - Fax:
Practice Address - Street 1:3240 BURNT MILL DR STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2570
Practice Address - Country:US
Practice Address - Phone:910-790-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health