Provider Demographics
NPI:1891305090
Name:THOMPSON, OLIVIA GRAYCE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:GRAYCE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EMERSON LN STE 1525
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-3484
Mailing Address - Country:US
Mailing Address - Phone:412-414-5925
Mailing Address - Fax:412-257-1571
Practice Address - Street 1:100 EMERSON LN STE 1525
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-3484
Practice Address - Country:US
Practice Address - Phone:412-414-5925
Practice Address - Fax:412-257-1571
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0212901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical