Provider Demographics
NPI:1013740877
Name:SAMANTHA L AMSES LLC
Entity type:Organization
Organization Name:SAMANTHA L AMSES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMSES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-433-4484
Mailing Address - Street 1:211 PLEASANT HOME RD STE G1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0560
Mailing Address - Country:US
Mailing Address - Phone:908-433-4484
Mailing Address - Fax:706-364-4589
Practice Address - Street 1:211 PLEASANT HOME RD STE G1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0560
Practice Address - Country:US
Practice Address - Phone:908-433-4484
Practice Address - Fax:706-364-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty