Provider Demographics
NPI:1073973376
Name:OLIVE, SHAYLEE (LICSW)
Entity Type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:
Last Name:OLIVE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 WAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-3771
Mailing Address - Country:US
Mailing Address - Phone:706-545-7401
Mailing Address - Fax:
Practice Address - Street 1:6498 WAY AVE
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-3771
Practice Address - Country:US
Practice Address - Phone:706-545-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other