Provider Demographics
NPI:1215522560
Name:SAMAYOA, MONIQUE R (LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:R
Last Name:SAMAYOA
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 RANDALL PKWY UNIT 3D
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2815
Mailing Address - Country:US
Mailing Address - Phone:910-795-5337
Mailing Address - Fax:
Practice Address - Street 1:1920 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6611
Practice Address - Country:US
Practice Address - Phone:910-632-2191
Practice Address - Fax:910-332-5739
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153721041C0700X
NC26814101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)