Provider Demographics
NPI:1093994949
Name:THOMAS, KEYONA SHANTRICE (PSYD, MA, LCPC)
Entity Type:Individual
Prefix:DR
First Name:KEYONA
Middle Name:SHANTRICE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD, MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 APOLLO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4785
Mailing Address - Country:US
Mailing Address - Phone:240-283-5595
Mailing Address - Fax:
Practice Address - Street 1:9701 APOLLO DR STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:240-283-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2555101YP2500X
DCPRC13986101YP2500X
VA0701008086101YP2500X
VA0810007740103TC0700X
DCPSY200001288103TC0700X
MD07013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444105200Medicaid