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General NPI Number Information
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NPI Number | 1376011734
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Entity Type | Individual
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Provider Name | SAMANTHA MARIE AMEND
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 139 N MAIN ST STE 308
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City | BEL AIR
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State | MD
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Zip | 21014-8808
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Country | US
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Telephone | 443-987-6190
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Fax |
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Provider Business Mailing Address
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Address Line | 612 E MACPHAIL RD
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City | BEL AIR
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State | MD
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Zip | 21014-4414
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Country | US
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Telephone | 443-632-7667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC10107
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License Number State | MD
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