Provider Demographics
NPI:1154767549
Name:KATY SAMPSON, PH.D., PLLC
Entity type:Organization
Organization Name:KATY SAMPSON, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-472-0637
Mailing Address - Street 1:5001 S MIAMI BLVD
Mailing Address - Street 2:325
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8526
Mailing Address - Country:US
Mailing Address - Phone:919-472-0637
Mailing Address - Fax:919-246-9390
Practice Address - Street 1:5001 S MIAMI BLVD
Practice Address - Street 2:325
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8526
Practice Address - Country:US
Practice Address - Phone:919-472-0637
Practice Address - Fax:919-246-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty