Provider Demographics
NPI:1326567678
Name:OLIVER, MELVIN MAX SR
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:MAX
Last Name:OLIVER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-1216
Mailing Address - Country:US
Mailing Address - Phone:804-739-5902
Mailing Address - Fax:804-739-6371
Practice Address - Street 1:13900 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-1216
Practice Address - Country:US
Practice Address - Phone:804-739-5902
Practice Address - Fax:804-739-6371
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2723103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities