=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649128059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEANNA GRACE SILES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2026
-----------------------------------------------------
Last Update Date | 03/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9400 GRAND BLVD APT 1603
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20774-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-710-3054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 GRAND BLVD APT 1603
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20774-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-710-3054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | AC3104
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------