Provider Demographics
NPI:1982147484
Name:NIEMEYER, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:NIEMEYER
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 1:207 DEEP ALY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6710
Mailing Address - Country:US
Mailing Address - Phone:803-528-9353
Mailing Address - Fax:
Practice Address - Street 1:1911 GADSDEN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-6400
Practice Address - Country:US
Practice Address - Phone:803-254-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health