Provider Demographics
NPI:1578856167
Name:OLSON, LISA (ASW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 LUPIN DR STE 8
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3956
Mailing Address - Country:US
Mailing Address - Phone:831-585-1895
Mailing Address - Fax:831-676-3325
Practice Address - Street 1:984 LUPIN DR STE 8
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3956
Practice Address - Country:US
Practice Address - Phone:831-585-1895
Practice Address - Fax:831-676-3325
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-28242104100000X
CAASW-35382104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker