Provider Demographics
NPI: | 1629457486 |
---|---|
Name: | FLINT, SAMANTHA RUTH (LCSW, CSW, ASW) |
Entity Type: | Individual |
Prefix: | |
First Name: | SAMANTHA |
Middle Name: | RUTH |
Last Name: | FLINT |
Suffix: | |
Gender: | F |
Credentials: | LCSW, CSW, ASW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2000 RING RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ELIZABETHTOWN |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42701-9454 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 760-853-4755 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2000 RING RD |
Practice Address - Street 2: | |
Practice Address - City: | ELIZABETHTOWN |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42701-9454 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-506-2730 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-05-27 |
Last Update Date: | 2021-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 256249 | 1041C0700X |
104100000X | ||
CA | 94751 | 101YM0800X, 1041C0700X |
OH | 1041C0700X | |
KY | 7251 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |