Healthcare Provider Details

I. General information

NPI: 1326786591
Provider Name (Legal Business Name): KIE-AIRE SAVOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 EDGEMEADE RD
UPPER MARLBORO MD
20772-8088
US

IV. Provider business mailing address

9207 FOX STREAM WAY
UPPER MARLBORO MD
20772-2520
US

V. Phone/Fax

Practice location:
  • Phone: 301-358-0192
  • Fax:
Mailing address:
  • Phone: 240-438-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28467
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28467
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: