Provider Demographics
NPI:1285681817
Name:BOOTH, OLGA LOUISE (MS, NCC, LGPC)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:LOUISE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MS, NCC, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 DEEP LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-9586
Mailing Address - Country:US
Mailing Address - Phone:180-049-1536
Mailing Address - Fax:410-882-1898
Practice Address - Street 1:8203 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5888
Practice Address - Country:US
Practice Address - Phone:800-491-5369
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGPC #147101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral