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General NPI Number Information
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NPI Number | 1457882920
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Entity Type | Individual
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Provider Name | DEANA THAXTON SAMMS MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 02/16/2020
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Provider Practice Location Address
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Address Line | 4501 MACCORKLE AVENUE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2530
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Country | US
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Telephone | 304-419-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 864 OLD TUPPERS CREEK RD
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City | CHARLESTON
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State | WV
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Zip | 25312-5456
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Country | US
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Telephone | 304-419-0177
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Fax | 304-345-4601
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1972
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License Number State | WV
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