Provider Demographics
NPI:1427344894
Name:SAMPSON, LEAH ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ELAINE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BEDDINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9251
Mailing Address - Country:US
Mailing Address - Phone:336-978-5866
Mailing Address - Fax:
Practice Address - Street 1:5509 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6312
Practice Address - Country:US
Practice Address - Phone:919-573-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0103331041C0700X
NC0080021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical