Provider Demographics
NPI:1538389275
Name:NDUPU, SAMUEL (LPC, LCAS, CCS)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:NDUPU
Suffix:
Gender:M
Credentials:LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 COMMONWEALTH AVE
Mailing Address - Street 2:116
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7654
Mailing Address - Country:US
Mailing Address - Phone:704-497-6953
Mailing Address - Fax:
Practice Address - Street 1:2121 COMMONWEALTH AVE
Practice Address - Street 2:116
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7654
Practice Address - Country:US
Practice Address - Phone:704-497-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC725101YA0400X
NC4936101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional