Healthcare Provider Details

I. General information

NPI: 1932758562
Provider Name (Legal Business Name): SAMANTHA ANN DIAMOND MA, LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARRIAGE LN SUITE 102, BUILDING B
CHARLESTON SC
29407
US

IV. Provider business mailing address

1 CARRIAGE LN SUITE 102, BUILDING B
CHARLESTON SC
29407
US

V. Phone/Fax

Practice location:
  • Phone: 843-256-6736
  • Fax:
Mailing address:
  • Phone: 843-256-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7811
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberEL10649
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61677633
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7811
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7118
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10002172
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: