Provider Demographics
NPI:1689806929
Name:BROYLES, KEISHA LYNNE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:LYNNE
Last Name:BROYLES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 SOUTHWESTERN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3921
Mailing Address - Country:US
Mailing Address - Phone:443-267-7775
Mailing Address - Fax:
Practice Address - Street 1:5626 SOUTHWESTERN BLVD STE C
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3921
Practice Address - Country:US
Practice Address - Phone:443-267-7775
Practice Address - Fax:443-327-4751
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical