Doctor Name: | MR. SAMUEL CHRISTOPHER ROSA |
NPI Number: | 1396101655 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 1666 |
Business Practice Address: | 1505 Sunset Rd Collins, MS - 394286389 |
Business Phone Number: | 6012884915 |
Business Fax Number: | |
Mailing Address: | Po Box 18421, HATTIESBURG |
State: | MS |
Postal Code: | 394048400 |
Phone Number: | 6012884915 |
Fax Number: | |
NPI Enumeration Date: | 01/01/2016 |
NPI Last Update Date: | 01/01/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1666 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |