Provider Demographics
NPI:1063293876
Name:LANDRYSMITH, SAMANTHA (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LANDRYSMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1153 WIKAO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3992
Mailing Address - Country:US
Mailing Address - Phone:808-292-1395
Mailing Address - Fax:
Practice Address - Street 1:95-1153 WIKAO ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3992
Practice Address - Country:US
Practice Address - Phone:808-292-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health