Provider Demographics
NPI:1881347102
Name:LUMULA, SAMANTHA (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LUMULA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13965 STONEY GATE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3658
Mailing Address - Country:US
Mailing Address - Phone:858-245-3817
Mailing Address - Fax:
Practice Address - Street 1:13965 STONEY GATE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3658
Practice Address - Country:US
Practice Address - Phone:858-245-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOtherLICENSED MARRIAGE FAMILY THERAPY