Provider Demographics
NPI:1437989308
Name:GOLDMAN, SAMANTHA KIMBRELL (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KIMBRELL
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 S MILLEDGE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1262
Mailing Address - Country:US
Mailing Address - Phone:404-441-9567
Mailing Address - Fax:
Practice Address - Street 1:598 S MILLEDGE AVE STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1262
Practice Address - Country:US
Practice Address - Phone:404-441-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health