Provider Demographics
NPI:1588285167
Name:SIMON, SAMANTHA JO (PHD, LCMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD, LCMHC, NCC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SIMON
Other - Last Name:LOHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:2709 BLUE RIDGE RD STE 190
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:984-355-0422
Mailing Address - Fax:
Practice Address - Street 1:2709 BLUE RIDGE RD STE 190
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:984-355-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health