Provider Demographics
NPI:1831074657
Name:MCCORMICK, RIA TERRELLE
Entity type:Individual
Prefix:
First Name:RIA
Middle Name:TERRELLE
Last Name:MCCORMICK
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 FIELDWAY DR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4817
Mailing Address - Country:US
Mailing Address - Phone:443-500-1520
Mailing Address - Fax:
Practice Address - Street 1:8510 FIELDWAY DR
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4817
Practice Address - Country:US
Practice Address - Phone:443-500-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health