Active NPI
Calvary De'Rosa Sampson
- Mental Health Counselor
- Lafayette, LA
National Provider Identifier
1487305405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8073
- Practice address
- 1304 Bertrand Dr Ste E3
Lafayette, LA 70506-9105 - Phone
- (337) 221-0287
- Fax
- (884) 364-1683
- NPI assigned
- Jan 11, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PLC8073 | LA | |
| Mental Health Counselor | 101YM0800X | 8073 | LA | Primary |
Addresses
Primary practice location
1304 Bertrand Dr Ste E3
Lafayette, LA 70506-9105
Mailing address
1304 Bertrand Dr Ste E3
Lafayette, LA 70506-9105
Phone (337) 221-0287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8073 | LA | MD | Mental Health Counselor |
| PLC8073 | LA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643587200000",
"number": "1487305405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1304 BERTRAND DR STE E3",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705069105",
"telephone_number": "337-221-0287",
"fax_number": "884-364-1683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1304 BERTRAND DR STE E3",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705069105",
"telephone_number": "337-221-0287",
"fax_number": "884-364-1683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPSON",
"first_name": "CALVARY",
"middle_name": "DE'ROSA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-11",
"last_updated": "2022-01-31",
"certification_date": "2022-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "LA",
"license": "PLC8073",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "LA",
"license": "8073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.