Healthcare Provider Details

I. General information

NPI: 1659027456
Provider Name (Legal Business Name): KEISHA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 YORK RD
BALTIMORE MD
21212-4225
US

IV. Provider business mailing address

2612 CYLBURN AVE
BALTIMORE MD
21215-5318
US

V. Phone/Fax

Practice location:
  • Phone: 443-687-9821
  • Fax:
Mailing address:
  • Phone: 443-622-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP17286
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberR01570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: