Provider Demographics
NPI:1336661511
Name:EALY, ANGELA LYNNETTE (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNNETTE
Last Name:EALY
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNNETTE
Other - Last Name:MCCREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6319 MONTERY RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6926
Mailing Address - Country:US
Mailing Address - Phone:240-274-2840
Mailing Address - Fax:
Practice Address - Street 1:11400 GLENN DALE BLVD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9049
Practice Address - Country:US
Practice Address - Phone:301-352-0320
Practice Address - Fax:301-860-1258
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical