Provider Demographics
NPI:1528090016
Name:OLSON-DAVIDSON, LOTTIE GRACE (PHD, LPC, LCMHC)
Entity type:Individual
Prefix:DR
First Name:LOTTIE
Middle Name:GRACE
Last Name:OLSON-DAVIDSON
Suffix:
Gender:F
Credentials:PHD, LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 FORTUNA CENTER PLZ STE 192
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1515
Mailing Address - Country:US
Mailing Address - Phone:703-910-7529
Mailing Address - Fax:703-910-7555
Practice Address - Street 1:4222 FORTUNA CENTER PLZ STE 192
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1515
Practice Address - Country:US
Practice Address - Phone:703-910-7529
Practice Address - Fax:703-910-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK456101YM0800X
GA4402101YM0800X
AKC-4523101YA0400X
NCNC # 9490101YM0800X
DCPRC14303101YM0800X
SC9384101YP2500X
MECC7371101YP2500X
MEPC7218101YP2500X
VAVA #0701005309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional