Provider Demographics
NPI:1427515972
Name:SAMUEL, ALICIA-ANN (LMHC,NCC)
Entity type:Individual
Prefix:
First Name:ALICIA-ANN
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LMHC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 N UNIVERSITY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1700
Mailing Address - Country:US
Mailing Address - Phone:954-361-5032
Mailing Address - Fax:
Practice Address - Street 1:8400 N UNIVERSITY DR STE 111
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1700
Practice Address - Country:US
Practice Address - Phone:954-361-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health