Healthcare Provider Details

I. General information

NPI: 1841855434
Provider Name (Legal Business Name): SAMANTHA NICOLE RUDMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA KLINE LGPC

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6508 DEER POINTE DR STE 4
SALISBURY MD
21804-1668
US

IV. Provider business mailing address

6508 DEER POINTE DR STE 4C
SALISBURY MD
21804-1668
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-6016
  • Fax: 410-742-6014
Mailing address:
  • Phone: 410-742-6016
  • Fax: 410-742-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC15999
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: