Provider Demographics
NPI:1164149688
Name:O'DONNELL, LINDSEY (LGPC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E WEST SHADY SIDE RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20764-9713
Mailing Address - Country:US
Mailing Address - Phone:443-280-3052
Mailing Address - Fax:
Practice Address - Street 1:5419 DEALE CHURCHTON RD STE 104
Practice Address - Street 2:
Practice Address - City:CHURCHTON
Practice Address - State:MD
Practice Address - Zip Code:20733-2408
Practice Address - Country:US
Practice Address - Phone:410-541-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13187101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor