Provider Demographics
NPI:1437969417
Name:SAMSON, WINTANA
Entity type:Individual
Prefix:
First Name:WINTANA
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 BEAVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3063
Mailing Address - Country:US
Mailing Address - Phone:240-480-7028
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL STE 208
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2649
Practice Address - Country:US
Practice Address - Phone:301-615-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst