Provider Demographics
NPI:1356742324
Name:OLINICK, DANNA (LCPC)
Entity type:Individual
Prefix:
First Name:DANNA
Middle Name:
Last Name:OLINICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 PEAR TREE POINT RD
Mailing Address - Street 2:PO BOX 637
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-2342
Mailing Address - Country:US
Mailing Address - Phone:801-735-7815
Mailing Address - Fax:
Practice Address - Street 1:315 HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1326
Practice Address - Country:US
Practice Address - Phone:801-735-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5248852-6004101YM0800X
MDLC5718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0845051Medicaid