Provider Demographics
NPI:1306908009
Name:SHEREE L. SAMPSON
Entity type:Organization
Organization Name:SHEREE L. SAMPSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:LOCKLEAR
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-827-1169
Mailing Address - Street 1:16 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8540
Mailing Address - Country:US
Mailing Address - Phone:910-827-1169
Mailing Address - Fax:910-593-3577
Practice Address - Street 1:16 STANLEY ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8540
Practice Address - Country:US
Practice Address - Phone:910-827-1169
Practice Address - Fax:910-593-3577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEREE L. SAMPSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078170322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children