Provider Demographics
NPI:1255784997
Name:MCCOLL, TERRI LAJUAN (LGPC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LAJUAN
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 DOWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6882
Mailing Address - Country:US
Mailing Address - Phone:301-674-1243
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE 250
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3527
Practice Address - Country:US
Practice Address - Phone:301-674-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional