Provider Demographics
NPI:1871241919
Name:FORD, OLIVIA (LMSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 NELSON WAY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0723
Mailing Address - Country:US
Mailing Address - Phone:901-319-2815
Mailing Address - Fax:
Practice Address - Street 1:6650 NELSON WAY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0723
Practice Address - Country:US
Practice Address - Phone:901-304-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker