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
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912193160 NPPES
North Carolina MEDICAID 6111959

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