Organization
SAMANTHA L CHARBONNEAU PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAMANTHA LYNN CHARBONNEAU LMFT (MARRIAGE AND FAMILY THERAPIST)
(407) 466-3467
Entity
Organization
Contact information
Practice address
101 TIMBERLACHEN CIR STE 201, LAKE MARY, FL 32746-6124
(407) 466-3467
(407) 549-5987
Mailing address
101 TIMBERLACHEN CIR STE 201, LAKE MARY, FL 32746-6124
(407) 466-3467
(407) 549-5987
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT2058
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982634275
NPI TYPE 1
FL
Enumeration date
05/11/2017
Last updated
05/11/2017
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