Individual
SAMANTHA RUSSELL-PORTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
519 BLACK PEARL CIR, JACKSONVILLE, NC 28546-0157
(571) 535-4655
Mailing address
519 BLACK PEARL CIR, JACKSONVILLE, NC 28546-0157
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0717001958
VA
Other
Enumeration date
10/26/2022
Last updated
05/01/2026
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