Healthcare Provider Details

I. General information

NPI: 1255921888
Provider Name (Legal Business Name): SAMANTHA NUMIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 ROCKLAND RD
EWING NJ
08638-1551
US

IV. Provider business mailing address

61 ROCKLAND RD
EWING NJ
08638-1551
US

V. Phone/Fax

Practice location:
  • Phone: 609-362-6468
  • Fax: 609-256-4050
Mailing address:
  • Phone: 609-362-6468
  • Fax: 609-256-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00729100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: