Provider Demographics
NPI:1902811565
Name:SEARS, SAMUEL F JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:F
Last Name:SEARS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:FRAZER
Other - Last Name:SEARS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5538103T00000X
NC3500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047MAOtherBCBS NC
FL211932300Medicaid
NC6001068Medicaid
NC2821299Medicare PIN
FL54151Medicare ID - Type Unspecified