Provider Demographics
NPI:1336473461
Name:SPINKS, SAMANTHA JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JO
Last Name:SPINKS
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 1:310 N MICHIGAN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1770
Mailing Address - Country:US
Mailing Address - Phone:574-935-9449
Mailing Address - Fax:574-935-3956
Practice Address - Street 1:310 N MICHIGAN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1770
Practice Address - Country:US
Practice Address - Phone:574-935-9449
Practice Address - Fax:574-935-3956
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003514A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical