Provider Demographics
NPI:1417237249
Name:WILLS, OLIVIA CLAIRE
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:CLAIRE
Last Name:WILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF SOUTHERN CALIFORNIA
Mailing Address - Street 2:1031 WEST 34TH STREET, SUITE 304
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-3261
Mailing Address - Country:US
Mailing Address - Phone:213-740-7711
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTHERN CALIFORNIA
Practice Address - Street 2:1031 WEST 34TH STREET, SUITE 304
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3261
Practice Address - Country:US
Practice Address - Phone:213-740-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical