Provider Demographics
NPI:1972849487
Name:OLIVER, PEACHES J
Entity Type:Individual
Prefix:
First Name:PEACHES
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 WILLIAMSBOURGH DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2006
Mailing Address - Country:US
Mailing Address - Phone:916-395-3552
Mailing Address - Fax:916-473-5766
Practice Address - Street 1:4343 WILLIAMSBOURGH DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2006
Practice Address - Country:US
Practice Address - Phone:916-395-3552
Practice Address - Fax:916-473-5766
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)