Provider Demographics
NPI:1619716230
Name:THEIN, SAMANTHA (LSA, CADC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:THEIN
Suffix:
Gender:F
Credentials:LSA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22W382 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-3506
Mailing Address - Country:US
Mailing Address - Phone:801-631-3515
Mailing Address - Fax:
Practice Address - Street 1:1250 N MILL ST STE 101
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6305
Practice Address - Country:US
Practice Address - Phone:801-631-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health