Provider Demographics
NPI:1326412594
Name:SAMPSON, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SAMPSON
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 1:109 CHEVY LN
Mailing Address - Street 2:C
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1561
Mailing Address - Country:US
Mailing Address - Phone:318-346-6542
Mailing Address - Fax:318-346-6543
Practice Address - Street 1:109 CHEVY LN
Practice Address - Street 2:C
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1561
Practice Address - Country:US
Practice Address - Phone:318-346-6542
Practice Address - Fax:318-346-6543
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical