Provider Demographics
NPI:1851706311
Name:TOWNSEND, SAMUEL BENJAMIN (MAOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2264
Mailing Address - Country:US
Mailing Address - Phone:919-355-6567
Mailing Address - Fax:
Practice Address - Street 1:1520 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2264
Practice Address - Country:US
Practice Address - Phone:919-355-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist