Provider Demographics
NPI:1902271273
Name:HORSLEY, SAMANTHA (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HORSLEY
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:STATE PARK
Mailing Address - State:SC
Mailing Address - Zip Code:29147-0803
Mailing Address - Country:US
Mailing Address - Phone:803-896-6448
Mailing Address - Fax:
Practice Address - Street 1:3208 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5427
Practice Address - Country:US
Practice Address - Phone:803-896-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist