Provider Demographics
NPI:1194455568
Name:HAQUE, SAMANTA SABRINA
Entity type:Individual
Prefix:
First Name:SAMANTA
Middle Name:SABRINA
Last Name:HAQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CARMICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3691
Mailing Address - Country:US
Mailing Address - Phone:334-356-4900
Mailing Address - Fax:
Practice Address - Street 1:1320 CARMICHAEL WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3691
Practice Address - Country:US
Practice Address - Phone:334-356-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician