Provider Demographics
NPI:1821277112
Name:BLACKWELL, SAMANTHA BELLA (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:BELLA
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:RACHELLE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW
Mailing Address - Street 1:17273 STATE ROUTE 104
Mailing Address - Street 2:MAIL CODE 108CD
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8608
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:740-772-7196
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:MAIL CODE 108CD
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8608
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7196
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical