Provider Demographics
NPI:1902231871
Name:OLIVE BRANCH BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-758-3082
Mailing Address - Street 1:6243 BIG SANDY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5798
Mailing Address - Country:US
Mailing Address - Phone:919-758-3082
Mailing Address - Fax:225-590-3324
Practice Address - Street 1:6243 BIG SANDY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5798
Practice Address - Country:US
Practice Address - Phone:919-758-3082
Practice Address - Fax:225-590-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health