Healthcare Provider Details

I. General information

NPI: 1922407345
Provider Name (Legal Business Name): KANISHA R BARNES LCSW-C, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 MUESERBUSH CT
GLENARDEN MD
20706-5514
US

IV. Provider business mailing address

2908 MUESERBUSH CT
GLENARDEN MD
20706-5514
US

V. Phone/Fax

Practice location:
  • Phone: 443-743-2563
  • Fax: 301-591-6268
Mailing address:
  • Phone: 443-743-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC50081441
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: