Healthcare Provider Details

I. General information

NPI: 1134566672
Provider Name (Legal Business Name): SAMANTHA DIANE HAMAR LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEA DIANE SHIRA LMHCA

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 EVANSTON AVE N SUITE 415
SEATTLE WA
98103
US

IV. Provider business mailing address

3417 EVANSTON AVE N SUITE 415
SEATTLE WA
98103
US

V. Phone/Fax

Practice location:
  • Phone: 206-456-6754
  • Fax:
Mailing address:
  • Phone: 206-456-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60315060
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60882908
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: