Provider Demographics
NPI:1881719482
Name:NAM, SAMANTHA JU YOUNG (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JU YOUNG
Last Name:NAM
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 1:1065 RUGGLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7834
Mailing Address - Country:US
Mailing Address - Phone:503-855-9494
Mailing Address - Fax:
Practice Address - Street 1:1065 RUGGLESTONE WAY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-7834
Practice Address - Country:US
Practice Address - Phone:503-855-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45002106H00000X
106H00000X
ORT2909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist