Provider Demographics
NPI:1316456239
Name:PELKEY-FLOCK, SAMANTHA JEAN (LPC)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JEAN
Last Name:PELKEY-FLOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JEAN
Other - Last Name:PELKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2305
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:203-499-7348
Mailing Address - Fax:833-301-2087
Practice Address - Street 1:764 EAST MAIN ST
Practice Address - Street 2:APT B
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-499-7348
Practice Address - Fax:833-301-2087
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT46.004601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty