Provider Demographics
NPI:1265838163
Name:PIKE, SAMANTHA L (LADC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:PIKE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:L
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:125 ROBICHAUD RD
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4349
Mailing Address - Country:US
Mailing Address - Phone:207-951-6888
Mailing Address - Fax:
Practice Address - Street 1:125 ROBICHAUD RD
Practice Address - Street 2:
Practice Address - City:LEVANT
Practice Address - State:ME
Practice Address - Zip Code:04456-4349
Practice Address - Country:US
Practice Address - Phone:207-951-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5182101YA0400X
MELC6174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)