MEDICARE: NICOLE R SAMPSON PHD

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	103T00000X	Psychologist	0810003673	VA
2	103T00000X	Psychologist	PSY1000119	DC

General Provider Information

NPI Number	:	1902969132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R SAMPSON PHD

Provider Business Mailing Address
First Line	:	6512 LITTLE FALLS RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22213-1209
Country	:	US
Telephone Number	:	202-412-5966
Fax Number	:

Provider Business Practice Location Address
First Line	:	6512 LITTLE FALLS RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22213-1209
Country	:	US
Telephone Number	:	202-412-5966
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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Directions to “ NICOLE R SAMPSON PHD” Practice Location

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