Provider Demographics
NPI:1376812545
Name:DAHLIN, OLIVIA NICOLE (MFT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NICOLE
Last Name:DAHLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80483
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-0483
Mailing Address - Country:US
Mailing Address - Phone:949-207-9612
Mailing Address - Fax:
Practice Address - Street 1:27802 VISTA DEL LAGO STE E-3
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1100
Practice Address - Country:US
Practice Address - Phone:949-207-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist