Provider Demographics
NPI:1770816761
Name:SAMUELS, SHONTEL JAMISON (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:SHONTEL
Middle Name:JAMISON
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 FORCE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4624
Mailing Address - Country:US
Mailing Address - Phone:443-854-3498
Mailing Address - Fax:
Practice Address - Street 1:5605 FORCE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4624
Practice Address - Country:US
Practice Address - Phone:443-854-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical