Provider Demographics
NPI:1346606068
Name:WILLIS, SAMANTHA LYNN HARBOR (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN HARBOR
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 GADSDEN HIGHWAY SUITE 116 UNIT #282
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3900
Mailing Address - Country:US
Mailing Address - Phone:205-679-0943
Mailing Address - Fax:205-881-3072
Practice Address - Street 1:173 TUCKER ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080
Practice Address - Country:US
Practice Address - Phone:205-679-0943
Practice Address - Fax:205-881-3072
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AL3804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor