Provider Demographics
NPI:1699226050
Name:OLIVER, CARRIE (LSWAIC, SUDP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LSWAIC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 SE MILLPLAIN BLVD
Mailing Address - Street 2:SUITE #307
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-750-9635
Mailing Address - Fax:360-334-9541
Practice Address - Street 1:11818 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE #307
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5089
Practice Address - Country:US
Practice Address - Phone:360-750-9635
Practice Address - Fax:360-334-9541
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60580844101YA0400X
WASC61083956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC61083956OtherLSWAIC