Provider Demographics
NPI:1376138685
Name:OLIVA, NICOLE WELLS (AMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:WELLS
Last Name:OLIVA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3707
Mailing Address - Country:US
Mailing Address - Phone:310-853-0048
Mailing Address - Fax:
Practice Address - Street 1:2533 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3707
Practice Address - Country:US
Practice Address - Phone:310-853-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT124171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist