Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003010224 |
---|---|
Provider Name | Samantha Perkins |
First Address | Louisville, KY 40202-1423 |
Second Address | Shepherdsville, KY 40165-0690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 09/06/2011 |