Provider Demographics
NPI:1710379060
Name:CHRISTINE SAM MS, LPC, LLC
Entity Type:Organization
Organization Name:CHRISTINE SAM MS, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:907-866-3677
Mailing Address - Street 1:431 W 7TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3500
Mailing Address - Country:US
Mailing Address - Phone:907-868-3677
Mailing Address - Fax:
Practice Address - Street 1:431 W 7TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3500
Practice Address - Country:US
Practice Address - Phone:907-868-3677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLPC434261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)