Provider Demographics
NPI:1194440313
Name:LEGG, SAMANTHA (CRC, LCMHCA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:CRC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6063
Mailing Address - Country:US
Mailing Address - Phone:910-539-7816
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST # 800
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5861
Practice Address - Country:US
Practice Address - Phone:919-323-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health