Provider Demographics
NPI:1619284346
Name:BELLAMY, COREY T (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:T
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 WALKER MILL RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-4922
Mailing Address - Country:US
Mailing Address - Phone:301-254-4307
Mailing Address - Fax:
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:#212
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-856-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2366101YP2500X
DCPRC14057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional