Healthcare Provider Details

I. General information

NPI: 1831757996
Provider Name (Legal Business Name): YVETTE APRIL KINCHELOW-SMITH P. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 DOBBIN RD STE D
COLUMBIA MD
21045-4770
US

IV. Provider business mailing address

4318 DUNWOOD TER
BURTONSVILLE MD
20866-1377
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone: 301-580-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: