Provider Demographics
NPI:1326366550
Name:SAMPSON, AKEEDA ROSHAWN (P-LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AKEEDA
Middle Name:ROSHAWN
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 TRADEWINDS DR
Mailing Address - Street 2:APT. K
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2454
Mailing Address - Country:US
Mailing Address - Phone:910-474-1504
Mailing Address - Fax:
Practice Address - Street 1:415 TRADEWINDS DR
Practice Address - Street 2:APT. K
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2454
Practice Address - Country:US
Practice Address - Phone:910-474-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0043681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical