Provider Demographics
NPI:1790129799
Name:MAHON, SAMANTHA B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:B
Last Name:MAHON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W WILLIAMS ST STE 280
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5203
Mailing Address - Country:US
Mailing Address - Phone:919-412-5685
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:SUITE 231-C
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-412-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-20
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10542101YP2500X, 101YM0800X
NC10543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional