Active NPI
Keanna Grace Siles
- Addiction (Substance Use Disorder) Counselor
- Largo, MD
National Provider Identifier
1649128059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- AC3104
- Practice address
- 9400 Grand Blvd Apt 1603
Largo, MD 20774-2650 - Phone
- (301) 710-3054
- NPI assigned
- Mar 20, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | AC3104 | MD | Primary |
Addresses
Primary practice location
9400 Grand Blvd Apt 1603
Largo, MD 20774-2650
Mailing address
9400 Grand Blvd Apt 1603
Largo, MD 20774-2650
Phone (301) 710-3054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC3104 | MD | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773964800000",
"number": "1649128059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9400 GRAND BLVD APT 1603",
"city": "LARGO",
"state": "MD",
"postal_code": "207742650",
"telephone_number": "301-710-3054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9400 GRAND BLVD APT 1603",
"city": "LARGO",
"state": "MD",
"postal_code": "207742650",
"telephone_number": "301-710-3054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SILES",
"first_name": "KEANNA",
"middle_name": "GRACE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-03-20",
"last_updated": "2026-03-20",
"certification_date": "2026-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MD",
"license": "AC3104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Largo, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.