Provider Demographics
NPI:1821666983
Name:VALLECILLO, OLIVIA MICHAL (MA, LCMHC-A)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MICHAL
Last Name:VALLECILLO
Suffix:
Gender:F
Credentials:MA, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 THE OVERLOOK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-6855
Mailing Address - Country:US
Mailing Address - Phone:704-996-4502
Mailing Address - Fax:
Practice Address - Street 1:920 W KING ST STE B
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3467
Practice Address - Country:US
Practice Address - Phone:828-278-8282
Practice Address - Fax:828-575-5330
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health