Provider Demographics
NPI:1326318247
Name:BURKHARDT, SAMANTHA KIMBERLY (CRC, LPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KIMBERLY
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SHOOK RD STE 207
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7059
Mailing Address - Country:US
Mailing Address - Phone:570-251-0338
Mailing Address - Fax:
Practice Address - Street 1:106 SHOOK RD STE 207
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7059
Practice Address - Country:US
Practice Address - Phone:570-251-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006195101YM0800X, 101YP2500X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
006195OtherLPC