Provider Demographics
NPI:1467087023
Name:KECK, ANGELA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:KECK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 BACK ACRE CIR STE 290B
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7769
Mailing Address - Country:US
Mailing Address - Phone:301-703-8767
Mailing Address - Fax:410-857-4176
Practice Address - Street 1:6816 DEERPATH RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7392
Practice Address - Country:US
Practice Address - Phone:301-363-1063
Practice Address - Fax:443-545-7835
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10451101YP2500X
MDLGP4881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health