Provider Demographics
NPI:1396296422
Name:LEWIS, SAMANTHA LIN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LIN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:H
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:PO BOX 10162
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-0962
Mailing Address - Country:US
Mailing Address - Phone:714-510-2705
Mailing Address - Fax:
Practice Address - Street 1:11949 JEFFERSON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6336
Practice Address - Country:US
Practice Address - Phone:714-510-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 2924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health