Provider Demographics
NPI:1205523131
Name:SAMPSON, LANA (MS, PHD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GOTTWALD CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5000
Mailing Address - Country:US
Mailing Address - Phone:919-637-6867
Mailing Address - Fax:919-773-2037
Practice Address - Street 1:7621 PURFOY RD STE 105B
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-6985
Practice Address - Country:US
Practice Address - Phone:833-749-4584
Practice Address - Fax:919-205-9919
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health