Provider Demographics
NPI:1265173496
Name:SAMPSON, FAITH FLEMING (LCMHCA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:FLEMING
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ASHLEY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9722
Mailing Address - Country:US
Mailing Address - Phone:252-347-5372
Mailing Address - Fax:
Practice Address - Street 1:3491 EVANS ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-591-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health