Provider Demographics
NPI:1528408358
Name:SAMPSON, DEIDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 HAWTHORNE FALLS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-3970
Mailing Address - Country:US
Mailing Address - Phone:281-459-6878
Mailing Address - Fax:281-864-4338
Practice Address - Street 1:6550 HAWTHORNE FALLS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-3970
Practice Address - Country:US
Practice Address - Phone:281-459-6878
Practice Address - Fax:281-864-4338
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical