Provider Demographics
NPI:1083125819
Name:OLSON, MALLIN (BCBA, LABA, LBA)
Entity Type:Individual
Prefix:
First Name:MALLIN
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:BCBA, LABA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 CHAPEL HILL RD STE 135
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4649
Mailing Address - Country:US
Mailing Address - Phone:919-377-2399
Mailing Address - Fax:919-377-2395
Practice Address - Street 1:7980 CHAPEL HILL RD STE 135
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4649
Practice Address - Country:US
Practice Address - Phone:919-377-2399
Practice Address - Fax:919-377-2395
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1-20-43292OtherBCBA