Provider Demographics
NPI:1245066604
Name:KEMP, KADIJAH (LGPC)
Entity type:Individual
Prefix:
First Name:KADIJAH
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 JOYCETON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1332
Mailing Address - Country:US
Mailing Address - Phone:646-335-6191
Mailing Address - Fax:
Practice Address - Street 1:2905 MITCHELLVILLE RD STE 112
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1321
Practice Address - Country:US
Practice Address - Phone:301-298-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional