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NPI Code Detail

MEDICARE: SAMANTHA MOODY SOLOMON

MEDICARE: SAMANTHA MOODY SOLOMON
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
1101YP2500XProfessional Counselor11709SC

General Provider Information

NPI Number : 1689533366
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MOODY SOLOMON
Provider Business Mailing Address
First Line : 3012 MILLWOOD AVE
Second Line :
City : COLUMBIA
State : SC
Zip : 29205-1807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3012 MILLWOOD AVE
Second Line :
City : COLUMBIA
State : SC
Zip : 29205-1807
Country : US
Telephone Number : 803-470-6213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ SAMANTHA MOODY SOLOMON ” Practice Location

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