Provider Demographics
NPI:1821732009
Name:DELLSTON, OLIVIA GRACE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:DELLSTON
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 1:5 HOWELL ST APT 7
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4852
Mailing Address - Country:US
Mailing Address - Phone:609-214-4086
Mailing Address - Fax:
Practice Address - Street 1:5 HOWELL ST APT 7
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4852
Practice Address - Country:US
Practice Address - Phone:609-214-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP017399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health