Provider Demographics
NPI:1366944894
Name:SEMANCO, DAVID (MAC,CADC,CSAC,CAC-AD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SEMANCO
Suffix:
Gender:M
Credentials:MAC,CADC,CSAC,CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15329 BARNABAS TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5566
Mailing Address - Country:US
Mailing Address - Phone:571-264-1527
Mailing Address - Fax:
Practice Address - Street 1:2015 MARTINS GRANT CT
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1932
Practice Address - Country:US
Practice Address - Phone:410-721-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)