Provider Demographics
NPI:1851413322
Name:OLIVE, DENISE K (MS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:OLIVE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3623
Mailing Address - Country:US
Mailing Address - Phone:770-843-7506
Mailing Address - Fax:
Practice Address - Street 1:6255 BARFIELD RD NE
Practice Address - Street 2:SUITE 175
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4319
Practice Address - Country:US
Practice Address - Phone:770-843-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional