Provider Demographics
NPI:1477226850
Name:BIVENS, TAKEISHA (LMSW)
Entity Type:Individual
Prefix:
First Name:TAKEISHA
Middle Name:
Last Name:BIVENS
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 1:2712 GRESHAM WAY UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3957
Mailing Address - Country:US
Mailing Address - Phone:443-783-9366
Mailing Address - Fax:
Practice Address - Street 1:3200 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4010
Practice Address - Country:US
Practice Address - Phone:443-783-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor