Provider Demographics
NPI:1265971139
Name:SAMSON, AMBER REI (MS)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:REI
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 CLAGETT DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1972
Mailing Address - Country:US
Mailing Address - Phone:630-217-4698
Mailing Address - Fax:443-773-5624
Practice Address - Street 1:7212 CLAGETT DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-1972
Practice Address - Country:US
Practice Address - Phone:630-217-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2024-03-11
Deactivation Date:2024-02-28
Deactivation Code:
Reactivation Date:2024-03-11
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLGP8989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38-3876389Medicaid