Provider Demographics
NPI:1629090444
Name:OLIVE, MICHELE B (LCSW, CSOTP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:B
Last Name:OLIVE
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 POLARIS ST
Mailing Address - Street 2:BLDG 586
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461-1912
Mailing Address - Country:US
Mailing Address - Phone:757-862-0047
Mailing Address - Fax:
Practice Address - Street 1:472 POLARIS ST
Practice Address - Street 2:BLDG 586
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461-1912
Practice Address - Country:US
Practice Address - Phone:757-862-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical