Provider Demographics
NPI:1972214708
Name:LOUISSAINT, SAMUEL Y
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:Y
Last Name:LOUISSAINT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WHITE DR APT E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3046
Mailing Address - Country:US
Mailing Address - Phone:850-405-5331
Mailing Address - Fax:
Practice Address - Street 1:214 WHITE DR APT E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3046
Practice Address - Country:US
Practice Address - Phone:850-405-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW208441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty