Provider Demographics
NPI:1417413261
Name:BYRD, KIANA M (MED, LGPC)
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:M
Last Name:BYRD
Suffix:
Gender:F
Credentials:MED, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CULVER ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4515
Mailing Address - Country:US
Mailing Address - Phone:301-741-0979
Mailing Address - Fax:
Practice Address - Street 1:3210 CULVER ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4515
Practice Address - Country:US
Practice Address - Phone:301-741-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD83-3448762OtherIRS