Provider Demographics
NPI:1467153908
Name:SAMANTHA AVIS COUNSELING LLC
Entity Type:Organization
Organization Name:SAMANTHA AVIS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:513-277-1013
Mailing Address - Street 1:1198 CROSSPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7330
Mailing Address - Country:US
Mailing Address - Phone:513-277-1013
Mailing Address - Fax:
Practice Address - Street 1:7000 HOUSTON RD STE 2
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4874
Practice Address - Country:US
Practice Address - Phone:513-277-1013
Practice Address - Fax:859-993-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty