Healthcare Provider Details

I. General information

NPI: 1164149688
Provider Name (Legal Business Name): LINDSEY O'DONNELL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 LAWRIN CT
CHESAPEAKE BEACH MD
20732-4182
US

IV. Provider business mailing address

1470 E WEST SHADY SIDE RD
SHADY SIDE MD
20764-9713
US

V. Phone/Fax

Practice location:
  • Phone: 786-863-4874
  • Fax:
Mailing address:
  • Phone: 443-280-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC15708
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: