Provider Demographics
NPI:1952333429
Name:KONGKRAPHUN, KELEIGH DAWN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KELEIGH
Middle Name:DAWN
Last Name:KONGKRAPHUN
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 1:1548 SUNSWEPT DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5023
Mailing Address - Country:US
Mailing Address - Phone:443-604-4341
Mailing Address - Fax:
Practice Address - Street 1:44 E GORDON ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2916
Practice Address - Country:US
Practice Address - Phone:410-838-9000
Practice Address - Fax:410-838-8953
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD276938OtherCOMPSYCH
MD889318-01OtherCAREFIRST BCBS
MD10012610OtherAPS HEALTHCARE
MDT541-0073OtherCAREFIRST BCBS