Provider Demographics
NPI:1356796809
Name:SAMUELS, DARNITA DENISE (MSA, MA, LMFTA)
Entity type:Individual
Prefix:MS
First Name:DARNITA
Middle Name:DENISE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MSA, MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MCCULLOUGH DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:919-807-1692
Mailing Address - Fax:
Practice Address - Street 1:300 MCCULLOUGH DRIVE
Practice Address - Street 2:400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:919-807-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11036A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist