Provider Demographics
NPI:1043613334
Name:OLSEN, EMILY WEBB (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WEBB
Last Name:OLSEN
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 1:2609 MCVITTY RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3513
Mailing Address - Country:US
Mailing Address - Phone:540-774-7100
Mailing Address - Fax:
Practice Address - Street 1:2609 MCVITTY RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3513
Practice Address - Country:US
Practice Address - Phone:540-774-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2111101YM0800X
VA0701006215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health