Provider Demographics
NPI:1942895826
Name:UNDERWOOD-MOBLEY, OLIVETT D (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:OLIVETT
Middle Name:D
Last Name:UNDERWOOD-MOBLEY
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:DR
Other - First Name:OLIVETT
Other - Middle Name:D
Other - Last Name:UNDERWOOD-MOBLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW, LCSW
Mailing Address - Street 1:158 LITTLE ORANGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-6026
Mailing Address - Country:US
Mailing Address - Phone:352-448-1944
Mailing Address - Fax:
Practice Address - Street 1:158 LITTLE ORANGE LAKE DR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-6026
Practice Address - Country:US
Practice Address - Phone:352-448-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical