Provider Demographics
NPI:1245405091
Name:SHIELDS, SAMANTHA HOLBROOK (MFT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:HOLBROOK
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:HOLROOK
Other - Last Name:MACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:20059 ELFIN FOREST LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-6005
Mailing Address - Country:US
Mailing Address - Phone:858-442-6435
Mailing Address - Fax:
Practice Address - Street 1:4550 KEARNY VILLA RD STE 308
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1578
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health