Provider Demographics
NPI:1992880264
Name:LOLLAR, MANDA SHERITA (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:MANDA
Middle Name:SHERITA
Last Name:LOLLAR
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-422-7142
Mailing Address - Fax:
Practice Address - Street 1:6916 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2604
Practice Address - Country:US
Practice Address - Phone:410-205-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG10906104100000X
MD164391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550004Medicaid
MD259147000OtherMAGELLAN GROUP
517251OtherUHC MAMSI GROUP
DCR968OtherCAREFIRST FEDERAL GROUP
MDLM49EAOtherCAREFIRST BCBS GROUP