Provider Demographics
NPI:1669139218
Name:GIFT-ATTOH, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GIFT-ATTOH
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 1:2110 WASHINGTON BOULEVARD
Mailing Address - Street 2:SEQUOIA PLAZA 2
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4320
Mailing Address - Country:US
Mailing Address - Phone:571-319-7697
Mailing Address - Fax:
Practice Address - Street 1:2110 WASHINGTON BOULEVARD
Practice Address - Street 2:SEQUOIA PLAZA 2
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4320
Practice Address - Country:US
Practice Address - Phone:571-319-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool