Samantha Wathen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

13506 Issued in NC

Practice address

8512 Six Forks Rd Ste 101
Raleigh, NC 27615-3256

Phone

(919) 277-0253

NPI assigned

May 31, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindly Group, PLLCGroup PAC ID 3072744028, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindly Group, PLLC

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1306196944

  Mental Health, NC

  Medicare reassignment Care Compare group NPD
• Triangle Counseling Agency Inc.

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1356517627

  Mental Health

  NPD
• Optum Behavioral Care of North Carolina, P.C.

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1861371718
  NPD (past)

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1629426754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 LOFT LN APT 94",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276093887",
            "telephone_number": "919-609-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8512 SIX FORKS RD STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153256",
            "telephone_number": "919-277-0253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 Suwannee Trail St",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421037956",
            "country_code": "US",
            "telephone_number": "270-901-5000",
            "fax_number": "270-842-5268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-31",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A13506",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "13506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Barclay Watermulder
• Ashlea Waters, RD, LDN
• Elizabeth Rachel Waters, MSW, LCSW
• Kristen Waters, PHARMD.
• Marcenia Waters
• Ashley Watkins, OTR/L
• Charity S Watkins, PH.D.
• India Gabrielle Watkins
• Jared Lyle Watkins, CRNA
• Julianna Marie Watkins

• All providers in Raleigh, NC
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.