Provider Demographics
NPI:1710275854
Name:OLIVER, WADEAN RENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WADEAN
Middle Name:RENEE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 OLD MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-8738
Mailing Address - Country:US
Mailing Address - Phone:479-353-4741
Mailing Address - Fax:
Practice Address - Street 1:1658 US HIGHWAY 371
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-7064
Practice Address - Country:US
Practice Address - Phone:870-246-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5148-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical