Provider Demographics
NPI:1629807334
Name:GALL, SAMARA LUCINDA (MSW)
Entity type:Individual
Prefix:MS
First Name:SAMARA
Middle Name:LUCINDA
Last Name:GALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 ROLLING PATH RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-2317
Mailing Address - Country:US
Mailing Address - Phone:540-710-4214
Mailing Address - Fax:
Practice Address - Street 1:904 PRINCESS ANNE ST STE 407
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5804
Practice Address - Country:US
Practice Address - Phone:540-479-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906015688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker