Provider Demographics
NPI:1912378993
Name:SAMPSON, SHEREE L (LPCA)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:L
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 THREE HUNTS DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8998
Mailing Address - Country:US
Mailing Address - Phone:910-827-1169
Mailing Address - Fax:910-522-1464
Practice Address - Street 1:56 THREE HUNTS DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8998
Practice Address - Country:US
Practice Address - Phone:910-827-1169
Practice Address - Fax:910-522-1464
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional