Provider Demographics
NPI:1689940967
Name:ERVIN, SAMMI LEE (P-LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMMI
Middle Name:LEE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DOSETT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2278
Mailing Address - Country:US
Mailing Address - Phone:704-870-8108
Mailing Address - Fax:704-870-8110
Practice Address - Street 1:219 EAST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3423
Practice Address - Country:US
Practice Address - Phone:704-636-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0067371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical