Provider Demographics
NPI:1932817137
Name:DRAKE, SARA SAMSON (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SAMSON
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:SAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5566 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2814
Mailing Address - Country:US
Mailing Address - Phone:901-395-3580
Mailing Address - Fax:
Practice Address - Street 1:129 W PATRICK ST STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5682
Practice Address - Country:US
Practice Address - Phone:240-257-6830
Practice Address - Fax:240-745-3950
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker