Healthcare Provider Details

I. General information

NPI: 1083567366
Provider Name (Legal Business Name): SAMARA WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 E VILLAGE RD STE H
LONG BEACH CA
90808-1505
US

IV. Provider business mailing address

4433 E VILLAGE RD STE H
LONG BEACH CA
90808-1505
US

V. Phone/Fax

Practice location:
  • Phone: 310-883-5178
  • Fax:
Mailing address:
  • Phone: 310-883-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number153749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: