Leary, Samantha Diane
Leary, Samantha Diane is an individual health care provider with primary practice located at 725 Highland Ave , Winston Salem NC 27101-4206. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Leary, Samantha Diane can be contacted via phone (336) 607-8523.Contact Information
Primary practice address
725 Highland Ave
Winston Salem NC 27101-4206
Phone: (336) 607-8523
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 1043 | North Carolina |
Profile Details
NPI number | 1912193160 |
---|---|
LBN Legal business name | Leary, Samantha Diane |
Credentials | LCAS |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Sep 21st, 2007 |
Last updated | Jul 31st, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1912193160 | NPPES |
North Carolina | MEDICAID | 6111959 |
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