Individual
SAMANTHA UPSHAW MAXEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
332 HIGHLAND PARK DR, RICHMOND, KY 40475-3487
(859) 200-4961
Mailing address
332 HIGHLAND PARK DR, RICHMOND, KY 40475-3487
(859) 200-4961
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
104439
KY
101YP2500X
Professional Counselor
1320
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12789901
—
KY
Enumeration date
09/28/2011
Last updated
03/17/2018
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