Samantha Rose Kinkopf, MA, LHMC (MH 20499)

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

20499 Issued in FL

Practice address

4651 Salisbury Rd Ste 400
Jacksonville, FL 32256-6187

Phone

(646) 941-7645

NPI assigned

Mar 21, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Samantha Rose Shaffer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1235888082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 SALISBURY RD STE 400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566187",
            "telephone_number": "646-941-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 SALISBURY RD STE 400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566187",
            "telephone_number": "646-941-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINKOPF",
        "first_name": "SAMANTHA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "MA, LHMC (MH 20499)",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-21",
        "last_updated": "2024-05-03",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "20499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "SHAFFER",
            "middle_name": "ROSE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.