Provider Demographics
NPI:1689312365
Name:CARVER, OLLIS JR (LPCC)
Entity Type:Individual
Prefix:PROF
First Name:OLLIS
Middle Name:
Last Name:CARVER
Suffix:JR
Gender:M
Credentials:LPCC
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 6691
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-1691
Mailing Address - Country:US
Mailing Address - Phone:707-642-5139
Mailing Address - Fax:707-641-1104
Practice Address - Street 1:1100 ROSE DR STE 224
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3618
Practice Address - Country:US
Practice Address - Phone:707-642-5139
Practice Address - Fax:707-641-1104
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC-7370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional