Provider Demographics
NPI:1528343084
Name:O'DONNELL, ISALENA MERRITT (MAC LAC)
Entity type:Individual
Prefix:MRS
First Name:ISALENA
Middle Name:MERRITT
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8821 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2274
Mailing Address - Country:US
Mailing Address - Phone:443-691-2349
Mailing Address - Fax:
Practice Address - Street 1:1802 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4755
Practice Address - Country:US
Practice Address - Phone:443-691-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01940171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist