Healthcare Provider Details

I. General information

NPI: 1588568174
Provider Name (Legal Business Name): SAMANTHA MCLAIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 RED BANKS RD
VICTORIA VA
23974-2441
US

IV. Provider business mailing address

2542 RED BANKS RD
VICTORIA VA
23974-2441
US

V. Phone/Fax

Practice location:
  • Phone: 267-382-9374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: