Provider Demographics
NPI:1366187080
Name:SAMS, JOHNETTA
Entity type:Individual
Prefix:
First Name:JOHNETTA
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-1502
Mailing Address - Country:US
Mailing Address - Phone:202-618-0744
Mailing Address - Fax:
Practice Address - Street 1:1638 R ST NW STE 314-316
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6446
Practice Address - Country:US
Practice Address - Phone:202-618-0744
Practice Address - Fax:202-810-9097
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC82-5272962OtherMENTAL HEALTH