Basic Information
| Provider Information | |||||||||
| NPI: | 1528037587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMPSON | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSN, MA, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HARRA RD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457866147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409842992 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 915 S RIVERSIDE DR NE | ||||||||
| Address2: | |||||||||
| City: | MC CONNELSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437569102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E3742 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 379001 | 01 | OH | MOUNT CARMEL PIN | OTHER | 000000344255 | 01 | OH | ANTHEM PIN | OTHER | 307824 | 01 | OH | TRICARE/MHN PIN | OTHER | 7754636 | 01 | OH | AETNA PIN | OTHER | Y03742 | 01 | OH | THE HEALTH PLAN PIN | OTHER |