Provider Demographics
NPI:1477124386
Name:DAVIS, KYNDRA NIKEIA
Entity Type:Individual
Prefix:
First Name:KYNDRA
Middle Name:NIKEIA
Last Name:DAVIS
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 1:6807 OLD WATERLOO RD APT 838
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7196
Mailing Address - Country:US
Mailing Address - Phone:443-992-8438
Mailing Address - Fax:
Practice Address - Street 1:6253 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2020
Practice Address - Country:US
Practice Address - Phone:443-992-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD211271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical