Healthcare Provider Details

I. General information

NPI: 1306908009
Provider Name (Legal Business Name): SHEREE L. SAMPSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5973 MCLEOD DR
MAXTON NC
28364-7211
US

IV. Provider business mailing address

16 STANLEY ST
PEMBROKE NC
28372-8540
US

V. Phone/Fax

Practice location:
  • Phone: 910-827-1169
  • Fax: 910-593-3577
Mailing address:
  • Phone: 910-827-1169
  • Fax: 910-593-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL078170
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEREE L SAMPSON
Title or Position: OWNER
Credential:
Phone: 910-827-1169