Provider Demographics
NPI:1003318296
Name:FADUL, OLIVIA (LPC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:FADUL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ALVARADO PL
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1507
Mailing Address - Country:US
Mailing Address - Phone:256-527-8240
Mailing Address - Fax:
Practice Address - Street 1:14 ALVARADO PL
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1507
Practice Address - Country:US
Practice Address - Phone:256-527-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALNAOtherAM NOT REGISTERED WITH INSURANCE