Basic Information
| Provider Information | |||||||||
| NPI: | 1609068543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMARKOS | ||||||||
| FirstName: | ELAYNE | ||||||||
| MiddleName: | NIKI SARA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA-LMHC-LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 428 | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278414430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8002 KING HELIE BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346531435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278414430 | ||||||||
| FaxNumber: | 7278414436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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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 | 101YM0800X | MH-8995 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 6830 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.