Provider Demographics
NPI:1629223532
Name:OLIVER, VALDERAS BARKSDALE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:VALDERAS
Middle Name:BARKSDALE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3900
Mailing Address - Country:US
Mailing Address - Phone:410-262-0707
Mailing Address - Fax:410-367-7834
Practice Address - Street 1:9921 REISTERSTOWN RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3900
Practice Address - Country:US
Practice Address - Phone:410-262-0707
Practice Address - Fax:410-367-7834
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020644000Medicaid