Provider Demographics
NPI:1093392946
Name:MAGNUSON, OLIVIA (RBT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431B WEEKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8431
Mailing Address - Country:US
Mailing Address - Phone:252-677-5100
Mailing Address - Fax:252-677-5110
Practice Address - Street 1:1431B WEEKSVILLE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8431
Practice Address - Country:US
Practice Address - Phone:252-677-5100
Practice Address - Fax:252-677-5110
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician