Provider Demographics
NPI:1922148014
Name:BISHOP, YVETTE (LCPC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-0872
Mailing Address - Country:US
Mailing Address - Phone:301-885-7579
Mailing Address - Fax:301-934-2852
Practice Address - Street 1:11680 DOOLITTLE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3801
Practice Address - Country:US
Practice Address - Phone:301-885-7579
Practice Address - Fax:301-934-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033896600Medicaid
MD624LMedicare ID - Type Unspecified