Healthcare Provider Details

I. General information

NPI: 1013740877
Provider Name (Legal Business Name): SAMANTHA L AMSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PLEASANT HOME RD STE G1
AUGUSTA GA
30907-0560
US

IV. Provider business mailing address

211 PLEASANT HOME RD STE G1
AUGUSTA GA
30907-0560
US

V. Phone/Fax

Practice location:
  • Phone: 908-433-4484
  • Fax: 706-364-4589
Mailing address:
  • Phone: 908-433-4484
  • Fax: 706-364-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA L AMSES
Title or Position: LPC
Credential: LPC
Phone: 908-433-4484