Provider Demographics
NPI:1063065837
Name:BYRD, PAULA E I (MS, LCPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:E I
Last Name:BYRD
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CHAMBORLEY DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6149
Mailing Address - Country:US
Mailing Address - Phone:443-831-7989
Mailing Address - Fax:
Practice Address - Street 1:4236 PIMLICO RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6961
Practice Address - Country:US
Practice Address - Phone:443-478-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC13356OtherSTATE OF MARYLAND DEPARTMENT OF HEALTH