Provider Demographics
NPI:1427714492
Name:PERKINS, SAMUEL A (LCMHC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:PERKINS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 PAGE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8582
Mailing Address - Country:US
Mailing Address - Phone:984-789-6961
Mailing Address - Fax:
Practice Address - Street 1:4804 PAGE CREEK LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8582
Practice Address - Country:US
Practice Address - Phone:984-789-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCMHCA-A17125101YP2500X
NC17125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional