Provider Demographics
NPI:1700237872
Name:OSBORNE, SAMANTHA WADDELL (LPCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:WADDELL
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MICHELLE
Other - Last Name:WADDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 TUNNEL RD STE D
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1800
Mailing Address - Country:US
Mailing Address - Phone:828-350-1000
Mailing Address - Fax:
Practice Address - Street 1:119 TUNNEL RD STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1800
Practice Address - Country:US
Practice Address - Phone:828-350-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional