Provider Demographics
NPI:1275121907
Name:OLIVER, CHANDRA DENITA (ACA0007657 NLC0109)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:DENITA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ACA0007657 NLC0109
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:DENITA
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAT, NLC
Mailing Address - Street 1:10150 E VIRGINIA AVE # 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1350
Mailing Address - Country:US
Mailing Address - Phone:303-908-1376
Mailing Address - Fax:
Practice Address - Street 1:10150 E VIRGINIA AVE # 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1350
Practice Address - Country:US
Practice Address - Phone:303-908-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA0007657101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)