Provider Demographics
NPI:1659433431
Name:KING, OLIVIA W (LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:W
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0137
Mailing Address - Country:US
Mailing Address - Phone:812-479-1411
Mailing Address - Fax:812-437-2636
Practice Address - Street 1:3701 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0137
Practice Address - Country:US
Practice Address - Phone:812-479-1411
Practice Address - Fax:812-437-2636
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003438A1041C0700X
KY12121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000379073OtherANTHEM BC AND BS
IN636750DMedicare PIN