MEDICARE: SAMANTHA JOAN PEKA

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	101YM0800X	Mental Health Counselor	8127	SC

General Provider Information

NPI Number	:	1821876178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JOAN PEKA

Provider Business Mailing Address
First Line	:	209 TEA OLIVE AVE
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6935
Country	:	US
Telephone Number	:	706-726-9888
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 TEA OLIVE AVE
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6935
Country	:	US
Telephone Number	:	706-726-9888
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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Directions to “ SAMANTHA JOAN PEKA ” Practice Location

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