Provider Demographics
NPI:1184496960
Name:BRAY, SAMANTHA JO (CDCA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:BRAY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 STELLA COURT
Mailing Address - Street 2:LENORA ISAACS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1011
Mailing Address - Country:US
Mailing Address - Phone:614-252-8402
Mailing Address - Fax:
Practice Address - Street 1:2100 STELLA CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1011
Practice Address - Country:US
Practice Address - Phone:614-252-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)