MEDICARE: SAMANTHA PIERCE

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

General Provider Information

NPI Number	:	1962206565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PIERCE

Provider Business Mailing Address
First Line	:	14790 CASHEW AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5857
Country	:	US
Telephone Number	:	904-694-2552
Fax Number	:

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	04/03/2025

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Directions to “ SAMANTHA PIERCE ” Practice Location

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