Provider Demographics
NPI:1821667650
Name:OLIVER, AYANNA AHSHA
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:AHSHA
Last Name:OLIVER
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 1:1741 LEXINGTON AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3511
Mailing Address - Country:US
Mailing Address - Phone:929-422-9333
Mailing Address - Fax:
Practice Address - Street 1:978 NEW YORK 45
Practice Address - Street 2:SUITE 100
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-535-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health