Provider Demographics
NPI:1265834568
Name:WHITE, SAMARA (EAMP, LAC, LMP)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:EAMP, LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 NE 70TH ST UNIT 328
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5486
Mailing Address - Country:US
Mailing Address - Phone:206-395-9796
Mailing Address - Fax:
Practice Address - Street 1:4206 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7431
Practice Address - Country:US
Practice Address - Phone:206-395-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60503724171100000X
WAMA60461701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist