Provider Demographics
NPI:1528037587
Name:SAMPSON, DENISE M (MSN, MA, LPCC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MSN, MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARRA RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45786-6147
Mailing Address - Country:US
Mailing Address - Phone:740-984-2992
Mailing Address - Fax:
Practice Address - Street 1:915 S RIVERSIDE DR NE
Practice Address - Street 2:
Practice Address - City:MC CONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9102
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH379001OtherMOUNT CARMEL PIN
OH000000344255OtherANTHEM PIN
OH307824OtherTRICARE/MHN PIN
OH7754636OtherAETNA PIN
OHY03742OtherTHE HEALTH PLAN PIN