Healthcare Provider Details

I. General information

NPI: 1700740438
Provider Name (Legal Business Name): SAMANTHA MARIE WILMOTH LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S WESTGATE DR STE D
GREENSBORO NC
27407-1632
US

IV. Provider business mailing address

PO BOX 8879
ASHEVILLE NC
28814-8879
US

V. Phone/Fax

Practice location:
  • Phone: 866-700-1606
  • Fax: 866-338-5921
Mailing address:
  • Phone: 866-700-1606
  • Fax: 866-338-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022613
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: