MEDICARE: MR. NOAH EMMANUEL SAMPLES LCMHCA

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	A22930	NC

General Provider Information

NPI Number	:	1902739287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOAH EMMANUEL SAMPLES LCMHCA

Provider Business Mailing Address
First Line	:	68 RETREAT DR APT 305
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-1258
Country	:	US
Telephone Number	:	704-574-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 RETREAT DR APT 305
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-1258
Country	:	US
Telephone Number	:	704-574-3012
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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