Individual
SAMUEL SCOTT BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MDIV, LMFT
Contact information
Practice address
4601 LAKE BOONE TRL, SUITE 3B, RALEIGH, NC 27607-7503
(919) 760-5430
Mailing address
PO BOX 25032, RALEIGH, NC 27611-5032
(919) 760-5430
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT 1702
NC
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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