Provider Demographics
NPI:1043702582
Name:BUCHANAN, OLIVIA (LMSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:KATROSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2526
Mailing Address - Country:US
Mailing Address - Phone:864-590-4060
Mailing Address - Fax:
Practice Address - Street 1:490 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2526
Practice Address - Country:US
Practice Address - Phone:864-590-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC161421041C0700X
SC18-54609106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician