Provider Demographics
NPI:1285480087
Name:IGLESIA, KEARA ELIZABETH (LGPC)
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:ELIZABETH
Last Name:IGLESIA
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:KEARA
Other - Middle Name:ELIZABETH
Other - Last Name:FARREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 BROOKES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2799
Mailing Address - Country:US
Mailing Address - Phone:301-500-0253
Mailing Address - Fax:
Practice Address - Street 1:8 BROOKES AVE STE 200
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2799
Practice Address - Country:US
Practice Address - Phone:301-500-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health