Provider Demographics
NPI:1265094353
Name:CROKER, SAMANTHA LYNNE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:CROKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S Q ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7626
Mailing Address - Country:US
Mailing Address - Phone:805-757-0951
Mailing Address - Fax:
Practice Address - Street 1:408 S Q ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7626
Practice Address - Country:US
Practice Address - Phone:805-757-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)