Provider Demographics
NPI:1063182475
Name:JARVIS, SAMANTHA ANN (LCPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:JARVIS
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 1:324 E ANTIETAM ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5768
Mailing Address - Country:US
Mailing Address - Phone:301-797-2110
Mailing Address - Fax:301-671-1485
Practice Address - Street 1:1146 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:301-797-2110
Practice Address - Fax:301-671-1485
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11747101YM0800X
MDLC14186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health