Healthcare Provider Details

I. General information

NPI: 1740538081
Provider Name (Legal Business Name): SAMANTHA H NORDVOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W CATALINA DR
PHOENIX AZ
85017-5291
US

IV. Provider business mailing address

4747 N 7TH ST STE 100
PHOENIX AZ
85014-3654
US

V. Phone/Fax

Practice location:
  • Phone: 602-353-0703
  • Fax: 602-353-0715
Mailing address:
  • Phone: 602-279-7655
  • Fax: 602-264-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW10724
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-10724
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: