Provider Demographics
NPI:1104147651
Name:CONNER, ALAINA SAMPLES (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAINA
Middle Name:SAMPLES
Last Name:CONNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALAINA
Other - Middle Name:SAMPLES
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALAINA SAMPLES
Mailing Address - Street 1:610 CANDLER ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3334
Mailing Address - Country:US
Mailing Address - Phone:770-569-3839
Mailing Address - Fax:
Practice Address - Street 1:601 CANDLER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-569-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005800101YP2500X
GAPSY004369103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional