Individual
JACQUELINE KRISTINE SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 VALENCIA DR STE 109, JACKSONVILLE, NC 28546-6312
(910) 330-7559
Mailing address
61 CEDAR GROVE CT, CLAYTON, NC 27527-7006
(661) 618-9101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A22893
NC
101YM0800X
Mental Health Counselor
Primary
ASSOCIATEPENDING
NC
Other
Enumeration date
03/25/2026
Last updated
05/13/2026
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