Healthcare Provider Details

I. General information

NPI: 1255187530
Provider Name (Legal Business Name): SAMANTHA HARKEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 OCEAN AVE APT 1114
REVERE MA
02151-1472
US

IV. Provider business mailing address

656 OCEAN AVE APT 1114
REVERE MA
02151-1472
US

V. Phone/Fax

Practice location:
  • Phone: 508-826-6621
  • Fax:
Mailing address:
  • Phone: 617-752-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA HARKEY
Title or Position: MANAGER
Credential: LMHC
Phone: 508-826-6621