Provider Demographics
NPI:1679953160
Name:MALCOMB, SAMANTHA (LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MALCOMB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PLACERVILLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4200
Mailing Address - Country:US
Mailing Address - Phone:530-644-2412
Mailing Address - Fax:
Practice Address - Street 1:3343 CAPITAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7370
Practice Address - Country:US
Practice Address - Phone:916-917-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT122480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist