Provider Demographics
NPI:1376310904
Name:OLIVER, ANDREW (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 VANDERPOOL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6504
Mailing Address - Country:US
Mailing Address - Phone:586-713-2048
Mailing Address - Fax:
Practice Address - Street 1:737 VANDERPOOL DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6504
Practice Address - Country:US
Practice Address - Phone:586-713-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional