Provider Demographics
NPI:1992508873
Name:PREDUM, SEANTA
Entity type:Individual
Prefix:MRS
First Name:SEANTA
Middle Name:
Last Name:PREDUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14106 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1018
Mailing Address - Country:US
Mailing Address - Phone:616-617-0246
Mailing Address - Fax:
Practice Address - Street 1:3909 NATIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1192
Practice Address - Country:US
Practice Address - Phone:240-755-8089
Practice Address - Fax:202-271-4444
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM1076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist