Healthcare Provider Details

I. General information

NPI: 1508590902
Provider Name (Legal Business Name): SAMANTHA SALLADE LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 CHAPEL RIDGE RD STE 220
APEX NC
27502-8504
US

IV. Provider business mailing address

2414 BELLWYND DR
APEX NC
27539-3011
US

V. Phone/Fax

Practice location:
  • Phone: 919-355-9792
  • Fax:
Mailing address:
  • Phone: 757-469-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17664
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: