Provider Demographics
NPI:1588219471
Name:HETCHKOP, SAMANTHA (LGPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HETCHKOP
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PARK POTOMAC AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6987
Mailing Address - Country:US
Mailing Address - Phone:301-466-2994
Mailing Address - Fax:
Practice Address - Street 1:5652 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3574
Practice Address - Country:US
Practice Address - Phone:240-225-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health