Provider Demographics
NPI:1093050015
Name:REID, SAMANTHA NICOLE (BS, LPCC)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:REID
Suffix:
Gender:F
Credentials:BS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 E PITTSBURG CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9047
Mailing Address - Country:US
Mailing Address - Phone:606-389-5269
Mailing Address - Fax:
Practice Address - Street 1:1907 E PITTSBURG CHURCH RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9047
Practice Address - Country:US
Practice Address - Phone:606-389-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164139101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100339080Medicaid