Provider Demographics
NPI:1952646598
Name:MCCORMACK, LAURI H (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:H
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 CONSTELLATION DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-1341
Mailing Address - Country:US
Mailing Address - Phone:443-994-1048
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 206
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-768-6088
Practice Address - Fax:410-768-6444
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional