| NPI | 1003331182 |
|---|---|
| Former Name | SAMANTHA BLAIR WITCHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 2863) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2025-06-27 |