Provider Demographics
NPI:1346727096
Name:BAYNARD, SAMANTHA (LCPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BAYNARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 FALLS RD UNIT 566
Mailing Address - Street 2:
Mailing Address - City:BROOKLANDVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21022-7522
Mailing Address - Country:US
Mailing Address - Phone:443-835-7436
Mailing Address - Fax:
Practice Address - Street 1:6318 PRINCESS GARDEN PKWY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2935
Practice Address - Country:US
Practice Address - Phone:443-835-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional