Provider Demographics
NPI:1740943034
Name:DOVE, SAMANTHA JANE (MSW, LCSWA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JANE
Last Name:DOVE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WOOD GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-6955
Mailing Address - Country:US
Mailing Address - Phone:919-219-2366
Mailing Address - Fax:
Practice Address - Street 1:2003 E NC HIGHWAY 54 STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2483
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:919-682-5322
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical