Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 24986 | MD |
NPI | 1003468257 |
---|---|
Provider Name | Kayla Danielle Edwards |
First Address | Bowie, MD 20720-4436 |
Second Address | Bel Air, MD 21014-3485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 09/07/2019 |