Healthcare Provider Details

I. General information

NPI: 1275741985
Provider Name (Legal Business Name): AMANDA WILLIAMS SAMSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

PSC 405 BOX 3837
APO AE
09034-0039
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1066
  • Fax:
Mailing address:
  • Phone: 314-590-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3209
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: