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Individual

MS. SAMANTHA CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
120 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330-4599
(304) 513-3495
(800) 734-8498
Mailing address
1005 WHITE WILLOW WAY, MORGANTOWN, WV 26505-6119
(304) 513-3495
(800) 734-8498

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
138525
PA
104100000X
Social Worker
Primary
BP00946604
WV
104100000X
Social Worker
Primary
DP00946604
WV

Other

Enumeration date
01/07/2022
Last updated
04/09/2026
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