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General NPI Number Information
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NPI Number | 1598654865
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Entity Type | Individual
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Provider Name | SAMATHA MARIE DURAND
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Gender | Female
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1503 E PARK AVE APT W8
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City | VALDOSTA
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State | GA
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Zip | 31602-5318
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Country | US
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Telephone | 603-703-6336
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Fax |
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Provider Business Mailing Address
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Address Line | WEST 26TH STREET
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City | LYNN HAVEN
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State | FL
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Zip | 32444
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Country | US
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Telephone | 850-769-5371
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 22-1371-488560
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License Number State | GA
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