Provider Demographics
NPI:1508322884
Name:SAMPSON-CHAVIS, TAMMY JO (MA, LCAS)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JO
Last Name:SAMPSON-CHAVIS
Suffix:
Gender:F
Credentials:MA, LCAS
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCAS
Mailing Address - Street 1:88 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6084
Mailing Address - Country:US
Mailing Address - Phone:910-316-5180
Mailing Address - Fax:
Practice Address - Street 1:2003 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3149
Practice Address - Country:US
Practice Address - Phone:910-739-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23851101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508322884Medicaid