Provider Demographics
NPI:1972653418
Name:OLIVER, BRENDA DOU B (MSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:DOU B
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 WOLF CLUB LANE, SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8710
Mailing Address - Country:US
Mailing Address - Phone:404-808-4127
Mailing Address - Fax:404-344-4891
Practice Address - Street 1:3276 WOLF CLUB LANE, SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8710
Practice Address - Country:US
Practice Address - Phone:404-808-4127
Practice Address - Fax:404-344-4891
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0011481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical