Provider Demographics
NPI:1891413985
Name:MCKELVEY, DIANE M (EDD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 OLD ANNAPOLIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2146
Mailing Address - Country:US
Mailing Address - Phone:443-863-6993
Mailing Address - Fax:
Practice Address - Street 1:8950 OLD ANNAPOLIS RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2146
Practice Address - Country:US
Practice Address - Phone:443-863-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst