Provider Demographics
NPI:1801688957
Name:DERICHO, KIONA
Entity type:Individual
Prefix:
First Name:KIONA
Middle Name:
Last Name:DERICHO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 CENTRE PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2236
Mailing Address - Country:US
Mailing Address - Phone:240-342-2666
Mailing Address - Fax:
Practice Address - Street 1:8818 CENTRE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2236
Practice Address - Country:US
Practice Address - Phone:240-342-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician