1558440909 NPI number — MS. SAMANTHA DIANE LOCKE LPC-S,LMFT,MAC,MBACP

Table of content: MS. SAMANTHA DIANE LOCKE LPC-S,LMFT,MAC,MBACP (NPI 1558440909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558440909 NPI number — MS. SAMANTHA DIANE LOCKE LPC-S,LMFT,MAC,MBACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKE
Provider First Name:
SAMANTHA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC-S,LMFT,MAC,MBACP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558440909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 OLD GLOUCESTER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
BERKSHIRE
Provider Business Mailing Address Postal Code:
WC1N 3AX
Provider Business Mailing Address Country Code:
GB
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
YOUNGMINDED
Provider Second Line Business Practice Location Address:
27 OLD GLOUCESTER STREET
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
BERKSHIRE
Provider Business Practice Location Address Postal Code:
WC1N 3AX
Provider Business Practice Location Address Country Code:
GB
Provider Business Practice Location Address Telephone Number:
759-229-1220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  507582 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2932 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 1008 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1008 . This is a "L.M.F.T" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 392370 . This is a "MBACP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2932 . This is a "L. P. C." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 507582 . This is a "MASTER ADDICTION COUNSELOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".