Provider Demographics
NPI:1285738443
Name:SAMS, JULIE MARIE (MA ,LPC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MARIE
Last Name:SAMS
Suffix:
Gender:F
Credentials:MA ,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 HERITAGE CENTER DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5012
Mailing Address - Country:US
Mailing Address - Phone:919-556-6501
Mailing Address - Fax:919-556-4933
Practice Address - Street 1:1788 HERITAGE CENTER DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5012
Practice Address - Country:US
Practice Address - Phone:919-606-1880
Practice Address - Fax:919-556-4933
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3918101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102404Medicaid
8278OtherFIVE COUNTY MENTAL HEALTH
NC134VFOtherBCBS
NC134VFOtherNC HEALTH CHOICE