Provider Demographics
NPI:1164215455
Name:MILGRIM, SAMANTHA OLIVIA (MA , RC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:OLIVIA
Last Name:MILGRIM
Suffix:
Gender:F
Credentials:MA , RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15062 MAPLE GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-3019
Mailing Address - Country:US
Mailing Address - Phone:703-850-5835
Mailing Address - Fax:
Practice Address - Street 1:10455 WHITE GRANITE DR
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2764
Practice Address - Country:US
Practice Address - Phone:571-567-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704018013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional