Healthcare Provider Details

I. General information

NPI: 1407420201
Provider Name (Legal Business Name): CHYVANTE FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 RIDGELYS CHOICE DR STE 211
NOTTINGHAM MD
21236-3028
US

IV. Provider business mailing address

4439 BELAIR RD
BALTIMORE MD
21206-6337
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-8043
  • Fax:
Mailing address:
  • Phone: 410-617-8043
  • Fax: 410-624-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1732904
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: