Provider Demographics
NPI:1801504162
Name:ACEVEDO, SAMANTHA NICOLE
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:MEIGHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:691 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3827
Mailing Address - Country:US
Mailing Address - Phone:864-882-7563
Mailing Address - Fax:
Practice Address - Street 1:691 S OAK ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3827
Practice Address - Country:US
Practice Address - Phone:864-882-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)