MEDICARE: SAMANTHA ANN DIAMOND MA, LPC, LMHC

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	101YP2500X	Professional Counselor	7811	SC
2	101YM0800X	Mental Health Counselor	EL10649	NH
3	101YM0800X	Mental Health Counselor	61677633	WA
4	101YM0800X	Mental Health Counselor	7811	SC
5	101Y00000X	Counselor	7118	SC
6	101YM0800X	Mental Health Counselor	LMHC10002172	MA

General Provider Information

NPI Number	:	1932758562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ANN DIAMOND MA, LPC, LMHC

Provider Business Mailing Address
First Line	:	1 CARRIAGE LN
Second Line	:	SUITE 102, BUILDING B
City	:	CHARLESTON
State	:	SC
Zip	:	29407
Country	:	US
Telephone Number	:	843-256-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CARRIAGE LN
Second Line	:	SUITE 102, BUILDING B
City	:	CHARLESTON
State	:	SC
Zip	:	29407
Country	:	US
Telephone Number	:	843-256-6736
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	12/17/2025

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