Healthcare Provider Details

I. General information

NPI: 1245462167
Provider Name (Legal Business Name): SAMAR H KHLEIF LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 76TH AVE
LANDOVER HILLS MD
20784-1703
US

IV. Provider business mailing address

3511 PINEY WOODS PL APT C302
LAUREL MD
20724-5979
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-2121
  • Fax: 301-459-0675
Mailing address:
  • Phone: 301-362-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC2123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: