Healthcare Provider Details

I. General information

NPI: 1326952607
Provider Name (Legal Business Name): KEVIN LAMONT HENDERSON-WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 NIMITZ DR
DISTRICT HEIGHTS MD
20747-3316
US

IV. Provider business mailing address

7201 NIMITZ DR
DISTRICT HEIGHTS MD
20747-3316
US

V. Phone/Fax

Practice location:
  • Phone: 301-433-2244
  • Fax:
Mailing address:
  • Phone: 301-433-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM07253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: