Provider Demographics
NPI:1174757975
Name:MCCORD, ANGEL LARA (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LARA
Last Name:MCCORD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:ANGEL
Other - Middle Name:LARA
Other - Last Name:BETTLEYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:5216 TORRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4911
Mailing Address - Country:US
Mailing Address - Phone:570-847-8821
Mailing Address - Fax:
Practice Address - Street 1:1615 YORK RD STE 300
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5639
Practice Address - Country:US
Practice Address - Phone:443-470-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD187051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical