Provider Demographics
NPI:1659922961
Name:OLSON, KRISTA ELIZABETH (LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ELIZABETH
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
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 68
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0068
Mailing Address - Country:US
Mailing Address - Phone:203-623-0886
Mailing Address - Fax:
Practice Address - Street 1:440 NORTH WOLFE ROAD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085
Practice Address - Country:US
Practice Address - Phone:203-623-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93291041C0700X
MD245761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical