Provider Demographics
NPI:1639102817
Name:PAGGEOT, SAMANTHA E (BA, MS, LPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:PAGGEOT
Suffix:
Gender:F
Credentials:BA, MS, LPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:B
Other - Last Name:ENZOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4921 POND SHOALS CT UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1803
Mailing Address - Country:US
Mailing Address - Phone:843-236-2595
Mailing Address - Fax:
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional