Provider Demographics
NPI:1255481719
Name:OLSON, CHARLES A (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:OLSON
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9618 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3247
Mailing Address - Country:US
Mailing Address - Phone:301-589-9155
Mailing Address - Fax:
Practice Address - Street 1:10501 GEORGIA AVE.
Practice Address - Street 2:SUITE 407
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:800-234-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health