Provider Demographics
NPI:1699077396
Name:COLBERT, SAMARIA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:SAMARIA
Middle Name:MARIA
Last Name:COLBERT
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 1:2006 CEDAR FORK DR APT D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4590
Mailing Address - Country:US
Mailing Address - Phone:919-600-3444
Mailing Address - Fax:
Practice Address - Street 1:2006 CEDAR FORK DR APT D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4590
Practice Address - Country:US
Practice Address - Phone:919-600-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical