Healthcare Provider Details

I. General information

NPI: 1003331182
Provider Name (Legal Business Name): SAMANTHA BLAIR HALE M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA BLAIR WITCHER M.ED,PCMHT

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HIGHWAY 80 W STE R
CLINTON MS
39056
US

IV. Provider business mailing address

PO BOX 701
CLINTON MS
39060-0701
US

V. Phone/Fax

Practice location:
  • Phone: 601-473-2106
  • Fax: 601-473-2150
Mailing address:
  • Phone: 601-473-2106
  • Fax: 601-473-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2863
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: