Provider Demographics
NPI:1821879875
Name:BURRIS, OLIVIA CHEYENNE (CDCA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHEYENNE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTH ST APT 306
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2092
Mailing Address - Country:US
Mailing Address - Phone:407-874-0499
Mailing Address - Fax:
Practice Address - Street 1:355 E CAMPUS VIEW BLVD STE 285
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5680
Practice Address - Country:US
Practice Address - Phone:614-750-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.1860013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)