Provider Demographics
NPI:1033797733
Name:IVORY, SHAYLYNNKINNE YVONNA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHAYLYNNKINNE
Middle Name:YVONNA
Last Name:IVORY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 POSTGATE TER APT 301
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6023
Mailing Address - Country:US
Mailing Address - Phone:313-544-8193
Mailing Address - Fax:
Practice Address - Street 1:702 RUSSELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2605
Practice Address - Country:US
Practice Address - Phone:301-330-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLMSW-26981OtherSTATE BOARD OF SOCIAL WORK LICENSE