Provider Demographics
NPI:1861831349
Name:SAMAD, FAIZA SHEIKH (MED)
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:SHEIKH
Last Name:SAMAD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 CLUB LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3681
Mailing Address - Country:US
Mailing Address - Phone:832-276-4663
Mailing Address - Fax:
Practice Address - Street 1:102 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6705
Practice Address - Country:US
Practice Address - Phone:832-276-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70735101YP2500X
ARP1509106101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional