Provider Demographics
NPI:1245735919
Name:WHITE, KYESHIA
Entity Type:Individual
Prefix:
First Name:KYESHIA
Middle Name:
Last Name:WHITE
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 1:5268 NICHOLSON LN # 188G
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5268-G NICHOLSON LANE #188
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MA
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:571-317-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician