Provider Demographics
NPI:1972041911
Name:CORNELIA ISRAEL, LCPC, LLC
Entity type:Organization
Organization Name:CORNELIA ISRAEL, LCPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:IOLANDA
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-802-7816
Mailing Address - Street 1:7 GRANARY DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6367
Mailing Address - Country:US
Mailing Address - Phone:443-802-7816
Mailing Address - Fax:
Practice Address - Street 1:20 PLEASANT RIDGE DR
Practice Address - Street 2:SUITE H
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2560
Practice Address - Country:US
Practice Address - Phone:443-802-7816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty