Provider Demographics
NPI:1407249014
Name:OLIVA, JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BARROW ST STE 313
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4764
Mailing Address - Country:US
Mailing Address - Phone:985-293-7401
Mailing Address - Fax:985-293-7840
Practice Address - Street 1:801 BARROW ST STE 313
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4764
Practice Address - Country:US
Practice Address - Phone:985-293-7401
Practice Address - Fax:985-293-7840
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical