Individual
MRS. SAMANTHA BROOKE JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
5807 HARFORD RD, BALTIMORE, MD 21214-1895
(410) 444-2100
(410) 426-1140
Mailing address
5807 HARFORD RD, BALTIMORE, MD 21214-1895
(410) 444-2100
(410) 426-1140
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
934
MD
104100000X
Social Worker
Primary
173371
MD
1041C0700X
Clinical Social Worker
173371
MD
1041S0200X
School Social Worker
173371
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
MD
Enumeration date
10/03/2019
Last updated
10/03/2019
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