Provider Demographics
NPI:1528302213
Name:WITT, SAMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15407 WALNUT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1607
Mailing Address - Country:US
Mailing Address - Phone:870-413-6205
Mailing Address - Fax:
Practice Address - Street 1:2615 N PRICKETT RD STE 7
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7546
Practice Address - Country:US
Practice Address - Phone:501-786-7800
Practice Address - Fax:501-406-2705
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7282-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical