Provider Demographics
NPI:1558440909
Name:LOCKE, SAMANTHA DIANE (LPC-S,LMFT,MAC,MBACP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:DIANE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:LPC-S,LMFT,MAC,MBACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OLD GLOUCESTER STREET
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:BERKSHIRE
Mailing Address - Zip Code:WC1N 3AX
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:YOUNGMINDED
Practice Address - Street 2:27 OLD GLOUCESTER STREET
Practice Address - City:LONDON
Practice Address - State:BERKSHIRE
Practice Address - Zip Code:WC1N 3AX
Practice Address - Country:GB
Practice Address - Phone:759-229-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA507582101YA0400X
LA2932101YP2500X
LA1008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1008OtherL.M.F.T
392370OtherMBACP
LA2932OtherL. P. C.
VA507582OtherMASTER ADDICTION COUNSELOR