Healthcare Provider Details

I. General information

NPI: 1871440586
Provider Name (Legal Business Name): KEVIN GRAYSON LINEBERGER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5413 BRENNER ST
CAPITOL HEIGHTS MD
20743-6211
US

IV. Provider business mailing address

5413 BRENNER ST
CAPITOL HEIGHTS MD
20743-6211
US

V. Phone/Fax

Practice location:
  • Phone: 202-345-4831
  • Fax:
Mailing address:
  • Phone: 202-345-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number208598112
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: