Provider Demographics
NPI:1386221182
Name:OLIVER, PAMELA LEI (LMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEI
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 ENTERPRISE DR STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-5697
Mailing Address - Country:US
Mailing Address - Phone:229-316-2606
Mailing Address - Fax:
Practice Address - Street 1:348 ENTERPRISE DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5697
Practice Address - Country:US
Practice Address - Phone:229-316-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007523104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker