Provider Demographics
NPI:1659032399
Name:OLSON, JILLIAN ELIZABETH (LDAC, LIMHP, LPC)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:OLSON
Suffix:
Gender:F
Credentials:LDAC, LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6478 BELROI RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3836
Mailing Address - Country:US
Mailing Address - Phone:757-709-1437
Mailing Address - Fax:
Practice Address - Street 1:6478 BELROI RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3836
Practice Address - Country:US
Practice Address - Phone:757-709-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103769101YA0400X
NE1477101YA0400X
VA0701012663101YM0800X
VA0718000616261QR0405X
NE12841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1477272912OtherNPI 2- GROUP
NE10027432500Medicaid