Healthcare Provider Details

I. General information

NPI: 1669289120
Provider Name (Legal Business Name): SAMANTHA TYER LCSW-A LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 GUARDIAN AVE
MOREHEAD CITY NC
28557-4323
US

IV. Provider business mailing address

3715 GUARDIAN AVE
MOREHEAD CITY NC
28557-4323
US

V. Phone/Fax

Practice location:
  • Phone: 828-386-7444
  • Fax:
Mailing address:
  • Phone: 252-222-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-30658
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: