Provider Demographics
NPI:1811599244
Name:HINTON, SAMANTHA (LADC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HINTON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 GREELEY ST S STE 210
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6059
Mailing Address - Country:US
Mailing Address - Phone:612-326-3981
Mailing Address - Fax:
Practice Address - Street 1:1940 GREELEY ST S STE 210
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6059
Practice Address - Country:US
Practice Address - Phone:612-326-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305575101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty