Provider Demographics
NPI:1588233787
Name:OLIVE BAPTIST CHURCH, INC
Entity Type:Organization
Organization Name:OLIVE BAPTIST CHURCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-473-4461
Mailing Address - Street 1:1830 E OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7582
Mailing Address - Country:US
Mailing Address - Phone:850-473-4461
Mailing Address - Fax:850-473-0428
Practice Address - Street 1:1830 E OLIVE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7582
Practice Address - Country:US
Practice Address - Phone:850-473-4461
Practice Address - Fax:850-473-0428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLIVE BAPTIST CHURCH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty