Healthcare Provider Details

I. General information

NPI: 1073850335
Provider Name (Legal Business Name): JOLYCE ADELE O'NEILL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD SUITE L260
COLUMBIA MD
21046-1702
US

IV. Provider business mailing address

10005 OLD COLUMBIA RD SUITE L260
COLUMBIA MD
21046-1702
US

V. Phone/Fax

Practice location:
  • Phone: 443-259-0400
  • Fax: 443-259-0044
Mailing address:
  • Phone: 443-259-0400
  • Fax: 443-259-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5864
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: