Samantha Mitchell, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

13780 Issued in NC

Practice address

2732 Ann Elizabeth Dr
Burlington, NC 27215-6650

Phone

(336) 229-5905

NPI assigned

Mar 3, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Samantha Fogleman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Samantha Mitchell, PLLC

  • Mental Health Counselor
  • Burlington, NC
  • NPI 1376496216
  NPD Authorized official

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1972138659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 ANN ELIZABETH DR",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272156650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 ANN ELIZABETH DR",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272156650",
            "telephone_number": "336-229-5905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "SAMANTHA",
        "credential": "LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "13780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47-448805",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "FOGLEMAN",
            "credential": "LCMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Connie Jean Mitchell, LCMHC
• Tori Cidiciqua Mitchell
• Jordan Mitchener
• Mobile FNP Jrjohnson
• Nikisha Michelle Mock
• Joel B. Moffett, M.D.

• Professional Counselor in Burlington, NC
• Providers in Burlington, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.