Healthcare Provider Details

I. General information

NPI: 1639776594
Provider Name (Legal Business Name): SAMANTHA K ANDREWS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA POCHOWSKI

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 S JEFFERSON ST
PERRY FL
32348-5611
US

IV. Provider business mailing address

1706 S JEFFERSON ST
PERRY FL
32348-5611
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-2360
  • Fax:
Mailing address:
  • Phone: 850-270-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: