Provider Demographics
NPI:1366751042
Name:GARCIA-SAMUELS, CARLOS
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:GARCIA-SAMUELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 LAKE WOODARD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1071
Mailing Address - Country:US
Mailing Address - Phone:919-672-3939
Mailing Address - Fax:
Practice Address - Street 1:4287 LAKE WOODARD DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604
Practice Address - Country:US
Practice Address - Phone:919-672-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health