Healthcare Provider Details

I. General information

NPI: 1497266506
Provider Name (Legal Business Name): KIARA LATOYA SAMUELS LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E LOOCKERMAN ST STE 304
DOVER DE
19901-8305
US

IV. Provider business mailing address

9 E LOOCKERMAN ST STE 304
DOVER DE
19901-8305
US

V. Phone/Fax

Practice location:
  • Phone: 302-803-0916
  • Fax:
Mailing address:
  • Phone: 302-803-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCD-0000087
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1573
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0011502
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: