Healthcare Provider Details

I. General information

NPI: 1508786211
Provider Name (Legal Business Name): LUCY SAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 SWEDEN RD STE A2
CHARLOTTE NC
28273-5936
US

IV. Provider business mailing address

6607 PARK SOUTH DR
CHARLOTTE NC
28210-4741
US

V. Phone/Fax

Practice location:
  • Phone: 704-312-0517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberNH-7386
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: