Individual
KIONNA BASKERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
319 W PATRICK ST, FREDERICK, MD 21701-4855
(301) 640-5702
Mailing address
319 W PATRICK ST, FREDERICK, MD 21701-4855
(301) 640-5702
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGPC12457
MD
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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