MEDICARE: SAMANTHA L PIKE LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC5182	ME
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC6174	ME

General Provider Information

NPI Number	:	1265838163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA L PIKE LADC

Provider Business Mailing Address
First Line	:	125 ROBICHAUD RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4349
Country	:	US
Telephone Number	:	207-951-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 ROBICHAUD RD
Second Line	:
City	:	LEVANT
State	:	ME
Zip	:	04456-4349
Country	:	US
Telephone Number	:	207-951-6888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	12/19/2016

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