Provider Demographics
NPI:1164016846
Name:OLIVER, LATARSHIA KATRICE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LATARSHIA
Middle Name:KATRICE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690443
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7008
Mailing Address - Country:US
Mailing Address - Phone:980-335-9869
Mailing Address - Fax:
Practice Address - Street 1:4917 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6611
Practice Address - Country:US
Practice Address - Phone:704-567-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0152061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical