Healthcare Provider Details

I. General information

NPI: 1003752650
Provider Name (Legal Business Name): SAMANTHA HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 NC 24-87
CAMERON NC
28326-6752
US

IV. Provider business mailing address

3094 MARKS RD
CAMERON NC
28326-8579
US

V. Phone/Fax

Practice location:
  • Phone: 910-260-4059
  • Fax: 919-869-1685
Mailing address:
  • Phone: 984-368-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: