Healthcare Provider Details

I. General information

NPI: 1124800388
Provider Name (Legal Business Name): KEIRA D LEFTWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 WOODPARK LN APT 204
COLUMBIA MD
21046-2775
US

IV. Provider business mailing address

7610 WOODPARK LN APT 204
COLUMBIA MD
21046-2775
US

V. Phone/Fax

Practice location:
  • Phone: 240-855-4116
  • Fax:
Mailing address:
  • Phone: 240-855-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200007961
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: