CARMEN K SAMPLES Social Worker License verification

Business Entity

NOT RENEWED

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149001398

License Status

NOT RENEWED

Business

First Name

CARMEN K

Last Name

SAMPLES

Business Name

CARMEN K SAMPLES

Original Issue Date

12/30/1989

Effective Date

01/14/2004

Expiration Date

11/30/2003

City

BATAVIA

State

Zip

60510

County

KANE

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

10/28/2006