Provider Demographics
NPI:1316599566
Name:OLIVER COUNSELING SERVICE
Entity Type:Organization
Organization Name:OLIVER COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-631-7172
Mailing Address - Street 1:4665 OAKLEIGH MANOR DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4937
Mailing Address - Country:US
Mailing Address - Phone:678-631-7172
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON ST STE 8
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4054
Practice Address - Country:US
Practice Address - Phone:678-631-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health