Provider Demographics
NPI:1629452909
Name:YEARICK, JOHN KYLE (LGPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KYLE
Last Name:YEARICK
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 HERALD HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1619
Mailing Address - Country:US
Mailing Address - Phone:240-925-0573
Mailing Address - Fax:
Practice Address - Street 1:9314 PISCATAWAY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3630
Practice Address - Country:US
Practice Address - Phone:301-856-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP6408OtherPROFESSIONAL COUNSELING LICENSE