Healthcare Provider Details

I. General information

NPI: 1467115071
Provider Name (Legal Business Name): SAMIYA KINNEY LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WICKER ST
SANFORD NC
27330-4151
US

IV. Provider business mailing address

607 WICKER ST
SANFORD NC
27330-4151
US

V. Phone/Fax

Practice location:
  • Phone: 919-292-2614
  • Fax: 919-964-3374
Mailing address:
  • Phone: 919-292-2614
  • Fax: 919-964-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: