Individual
COURTNEY SAMANTHA WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LCSW, CCM
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 742-8387
Mailing address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
65528
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65528
LSCW
TX
Enumeration date
10/20/2020
Last updated
07/25/2024
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