Provider Demographics
NPI:1346562774
Name:FRAZIER, OLIVIA CHANTE' (LPC)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:CHANTE'
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 OLD GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5930
Mailing Address - Country:US
Mailing Address - Phone:404-451-1631
Mailing Address - Fax:
Practice Address - Street 1:130 HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2097
Practice Address - Country:US
Practice Address - Phone:404-451-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional