Provider Demographics
NPI:1457246456
Name:AVILA, JA'NIEYAH MISHERRE JA'NAY
Entity type:Individual
Prefix:
First Name:JA'NIEYAH
Middle Name:MISHERRE JA'NAY
Last Name:AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 BRANDY STATION RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2414
Mailing Address - Country:US
Mailing Address - Phone:470-717-9944
Mailing Address - Fax:470-717-9944
Practice Address - Street 1:7500 GREENWAY CENTER DR STE 1300
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3575
Practice Address - Country:US
Practice Address - Phone:301-585-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-25-442666106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician