Healthcare Provider Details

I. General information

NPI: 1578294070
Provider Name (Legal Business Name): SAMANTHA NEWHAM ATC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PEPPERVINE CIR
DAYTON OH
45431-6414
US

IV. Provider business mailing address

101 PEPPERVINE CIR
DAYTON OH
45431-6414
US

V. Phone/Fax

Practice location:
  • Phone: 623-692-4152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405716
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-001420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: