Provider Demographics
NPI:1073279337
Name:SAMARA, MARK (MS, LGCP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SAMARA
Suffix:
Gender:M
Credentials:MS, LGCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AGORA DR STE LB2
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6863
Mailing Address - Country:US
Mailing Address - Phone:410-836-7332
Mailing Address - Fax:410-836-7422
Practice Address - Street 1:1201 AGORA DR STE LB2
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-6863
Practice Address - Country:US
Practice Address - Phone:410-836-7332
Practice Address - Fax:410-836-7422
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLPG12058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional