Healthcare Provider Details

I. General information

NPI: 1255240768
Provider Name (Legal Business Name): SAMANTHA SPENCER, MA, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 WILDFLOWER CIR
WILLISTON VT
05495-9391
US

IV. Provider business mailing address

277 WILDFLOWER CIR
WILLISTON VT
05495-9391
US

V. Phone/Fax

Practice location:
  • Phone: 860-463-8131
  • Fax:
Mailing address:
  • Phone: 860-463-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SPENCER
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LCMHC
Phone: 860-463-8131