Provider Demographics
NPI:1740987791
Name:GLANVILLE, KEYONA
Entity type:Individual
Prefix:
First Name:KEYONA
Middle Name:
Last Name:GLANVILLE
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 1:6921 RED CLAY FRG UNIT 203
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6380
Mailing Address - Country:US
Mailing Address - Phone:240-821-8092
Mailing Address - Fax:
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3561
Practice Address - Country:US
Practice Address - Phone:443-656-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician