Provider Demographics
NPI:1710471867
Name:OLIVIER, WILHELMINA CHRISTINA
Entity Type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:CHRISTINA
Last Name:OLIVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-1439
Mailing Address - Country:US
Mailing Address - Phone:507-450-4310
Mailing Address - Fax:
Practice Address - Street 1:924 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2351
Practice Address - Country:US
Practice Address - Phone:507-450-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303481101YA0400X
MN18091104100000X
MN02001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker