Healthcare Provider Details

I. General information

NPI: 1386270924
Provider Name (Legal Business Name): T'KEYAH ALYSIA MYERS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E LOMBARD ST
BALTIMORE MD
21224-1731
US

IV. Provider business mailing address

927 POPPY DR
ABERDEEN MD
21001-1193
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-9620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC14089
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: