Healthcare Provider Details

I. General information

NPI: 1942780101
Provider Name (Legal Business Name): ADRIENNE VICTORIA SAMPSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3867 W MARKET ST # 204
AKRON OH
44333-4525
US

IV. Provider business mailing address

3867 W MARKET ST # 204
AKRON OH
44333-4525
US

V. Phone/Fax

Practice location:
  • Phone: 330-427-8545
  • Fax: 330-427-8331
Mailing address:
  • Phone: 330-427-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP.07752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: