Provider Demographics
NPI:1952139859
Name:ANDRADE, ANGELISA DOROTHY (LC15311)
Entity type:Individual
Prefix:
First Name:ANGELISA
Middle Name:DOROTHY
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:LC15311
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 CHERRY HILL RD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3713
Mailing Address - Country:US
Mailing Address - Phone:240-277-2885
Mailing Address - Fax:
Practice Address - Street 1:11320 CHERRY HILL RD UNIT 301
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3713
Practice Address - Country:US
Practice Address - Phone:240-277-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC15311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health