Provider Demographics
NPI:1407156094
Name:DUTTON, SAMANTHA EVERHART (MSW)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:EVERHART
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:EVERHART
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1591 BROWN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-6264
Mailing Address - Country:US
Mailing Address - Phone:423-458-2292
Mailing Address - Fax:
Practice Address - Street 1:322 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1306
Practice Address - Country:US
Practice Address - Phone:423-458-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI25904381041C0700X
WA603281091041C0700X
TN63091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical