Provider Demographics
NPI:1871521146
Name:O'DONNELL, ANITA MARIE (LPCMH)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S OLD BALTIMORE PIKE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHRISTIANA
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1540
Mailing Address - Country:US
Mailing Address - Phone:302-368-8870
Mailing Address - Fax:302-368-7453
Practice Address - Street 1:25 S OLD BALTIMORE PIKE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHRISTIANA
Practice Address - State:DE
Practice Address - Zip Code:19702-1540
Practice Address - Country:US
Practice Address - Phone:302-368-8870
Practice Address - Fax:302-368-7453
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC000147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health