Individual
SAMANTHA T WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
1321 E POPLAR ST, DEMING, NM 88030-4807
(575) 546-5951
(575) 546-5994
Mailing address
1321 E POPLAR ST, DEMING, NM 88030-4807
(575) 546-5951
(575) 546-5994
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
B-3929
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61353311
—
NM
Enumeration date
08/16/2019
Last updated
08/16/2019
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