Provider Demographics
NPI:1285381673
Name:ALTER, SAMANTHA REA (RADT-1)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:REA
Last Name:ALTER
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:REA
Other - Last Name:ALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RADT-1
Mailing Address - Street 1:13333 PALMDALE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9364
Mailing Address - Country:US
Mailing Address - Phone:760-241-4917
Mailing Address - Fax:
Practice Address - Street 1:13333 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9364
Practice Address - Country:US
Practice Address - Phone:760-487-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1459500322101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)