Individual
SAMANTHA N PETTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13833 TAPIA AVE, BAYOU LA BATRE, AL 36509-2515
(251) 450-2211
Mailing address
5750A SOUTHLAND DR, MOBILE, AL 36693-3316
(251) 450-5095
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3812C
AL
Other
Enumeration date
08/14/2015
Last updated
06/04/2020
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