Healthcare Provider Details

I. General information

NPI: 1255235917
Provider Name (Legal Business Name): SAM POYTA COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

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

19222 11TH AVE NE
SHORELINE WA
98155-2241
US

IV. Provider business mailing address

19222 11TH AVE NE
SHORELINE WA
98155-2241
US

V. Phone/Fax

Practice location:
  • Phone: 571-377-9384
  • Fax:
Mailing address:
  • Phone: 571-377-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA POYTA
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LICSW
Phone: 571-377-9384