Provider Demographics
NPI:1316327786
Name:KLUNK, SAMANTHA (LCPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KLUNK
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 1:102 OLD SOLOMONS ISLAND RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3879
Mailing Address - Country:US
Mailing Address - Phone:410-266-3058
Mailing Address - Fax:410-266-3257
Practice Address - Street 1:102 OLD SOLOMONS ISLAND RD STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3879
Practice Address - Country:US
Practice Address - Phone:410-266-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health