Healthcare Provider Details

I. General information

NPI: 1033006002
Provider Name (Legal Business Name): SAMANTHA DAUBER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 36TH ST
BELLINGHAM WA
98229-3272
US

IV. Provider business mailing address

1712 36TH ST
BELLINGHAM WA
98229-3272
US

V. Phone/Fax

Practice location:
  • Phone: 360-820-4197
  • Fax:
Mailing address:
  • Phone: 360-820-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCBT.CB.70008647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: