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General NPI Number Information
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NPI Number | 1770782294
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Entity Type | Individual
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Provider Name | SAMANTHA CLARK STOWELL LMBT
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Gender | Female
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 4904 WATERS EDGE DR STE 159
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City | RALEIGH
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State | NC
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Zip | 27606-2466
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Country | US
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Telephone | 919-306-2258
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Fax |
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Provider Business Mailing Address
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Address Line | 664 HAY RIVER ST
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City | GARNER
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State | NC
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Zip | 27529-6209
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Country | US
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Telephone | 919-306-2258
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3819
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License Number State | NC
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