Provider Demographics
NPI:1407015563
Name:OLANDU, ANTHONY U (PHD, LCAC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:U
Last Name:OLANDU
Suffix:
Gender:M
Credentials:PHD, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2363
Mailing Address - Country:US
Mailing Address - Phone:410-462-7076
Mailing Address - Fax:410-462-6893
Practice Address - Street 1:1611 BAKER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2363
Practice Address - Country:US
Practice Address - Phone:410-462-7076
Practice Address - Fax:410-462-6893
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA0001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10228391OtherAMERIGROUP