Basic Information
| Provider Information | |||||||||
| NPI: | 1568968816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | LAVAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 728 PAREV WAY | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207741690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023652690 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9475 LOTTSFORD RD | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016366504 | ||||||||
| FaxNumber: | 3016366509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LGP8532 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.