Healthcare Provider Details

I. General information

NPI: 1295110104
Provider Name (Legal Business Name): ANGELA VIOLA SAMPSON LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD STE A-UP
GARFIELD HEIGHTS OH
44125-2967
US

IV. Provider business mailing address

3301 ARCHMERE AVE
CLEVELAND OH
44109-5400
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone: 216-502-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: