Provider Demographics
NPI:1609299171
Name:TOLLIVER, ANISSA W (MA, PC)
Entity Type:Individual
Prefix:MS
First Name:ANISSA
Middle Name:W
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31325
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-0325
Mailing Address - Country:US
Mailing Address - Phone:513-785-6914
Mailing Address - Fax:513-785-6900
Practice Address - Street 1:8735 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3136
Practice Address - Country:US
Practice Address - Phone:513-785-6914
Practice Address - Fax:513-785-6900
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health