MEDICARE: SAMUEL A PERKINS LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LCMHCA-A17125	NC
2	101YM0800X	Mental Health Counselor	17125	NC

General Provider Information

NPI Number	:	1427714492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL A PERKINS LCMHC

Provider Business Mailing Address
First Line	:	4804 PAGE CREEK LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8582
Country	:	US
Telephone Number	:	984-789-6961
Fax Number	:

Provider Business Practice Location Address
First Line	:	4804 PAGE CREEK LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8582
Country	:	US
Telephone Number	:	984-789-6961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2021
Last Update Date	:	06/21/2023

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