Healthcare Provider Details

I. General information

NPI: 1497681282
Provider Name (Legal Business Name): KEVIN JARON HYMAN LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 TIMBER RIDGE LN
BRYANS ROAD MD
20616-6119
US

IV. Provider business mailing address

6624 TIMBER RIDGE LN
BRYANS ROAD MD
20616-6119
US

V. Phone/Fax

Practice location:
  • Phone: 757-515-2836
  • Fax:
Mailing address:
  • Phone: 757-515-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLG50082191
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: