Individual
T'KEYAH ALYSIA LISBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5022 CAMPBELL BLVD, NOTTINGHAM, MD 21236-4969
(443) 442-1568
(443) 442-1569
Mailing address
5022 CAMPBELL BLVD, NOTTINGHAM, MD 21236-4969
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP11769
MD
Other
Enumeration date
03/16/2020
Last updated
08/06/2021
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