Provider Demographics
NPI:1497426597
Name:COBB, SAMANTHA MIKAEL (LCPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MIKAEL
Last Name:COBB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100F MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2018
Mailing Address - Country:US
Mailing Address - Phone:410-841-9647
Mailing Address - Fax:888-636-5301
Practice Address - Street 1:3100F MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-841-9647
Practice Address - Fax:888-636-5301
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14830101YM0800X
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health