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General NPI Number Information
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NPI Number | 1073095741
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Entity Type | Individual
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Provider Name | TAMARA ANN SAMUELS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1914 BRUNSWICK AVE STE 1B
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City | CHARLOTTE
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State | NC
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Zip | 28207-1891
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Country | US
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Telephone | 704-910-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 2329 MONTICELLO DR
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City | GASTONIA
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State | NC
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Zip | 28056-6563
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Country | US
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Telephone | 704-724-6206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C012184
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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