Provider Demographics
NPI:1538634688
Name:MCCOY, TRICIA L (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:L
Last Name:MCCOY
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 1:4103 53RD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1401
Mailing Address - Country:US
Mailing Address - Phone:240-351-2429
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 650
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3284
Practice Address - Country:US
Practice Address - Phone:240-351-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health