Provider Demographics
NPI:1699173393
Name:KELLEY, SAMANTHA AH (LPC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:AH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:AH
Other - Last Name:RHINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:319 ALABAMA 75
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951
Mailing Address - Country:US
Mailing Address - Phone:256-660-0796
Mailing Address - Fax:
Practice Address - Street 1:100 ANDREW ST # 2
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1971
Practice Address - Country:US
Practice Address - Phone:256-239-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL3440251S00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health