Provider Demographics
NPI:1649878505
Name:LARA, LEONOR I (LCPC)
Entity type:Individual
Prefix:MS
First Name:LEONOR
Middle Name:I
Last Name:LARA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:LEONOR
Other - Middle Name:ISABEL
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:3610 KAYSON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1943
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7348101YP2500X
MDLC12622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional