Healthcare Provider Details

I. General information

NPI: 1982183604
Provider Name (Legal Business Name): MARK ANDREW SAMS LCSW, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ROLLING ACRES DR
ARGYLE TX
76226
US

IV. Provider business mailing address

1413 ROLLING ACRES DR
ARGYLE TX
76226-6333
US

V. Phone/Fax

Practice location:
  • Phone: 817-296-4321
  • Fax:
Mailing address:
  • Phone: 817-296-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13043
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: