Provider Demographics
NPI:1982634275
Name:CHARBONNEAU, SAMANTHA L (LMFT, PA)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:L
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:LMFT, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TIMBERLACHEN CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6124
Mailing Address - Country:US
Mailing Address - Phone:407-466-3467
Mailing Address - Fax:407-549-5987
Practice Address - Street 1:101 TIMBERLACHEN CIR STE 201
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6124
Practice Address - Country:US
Practice Address - Phone:407-466-3467
Practice Address - Fax:407-549-5987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist