Provider Demographics
NPI:1336256270
Name:OLIVER, FREZALIA LAVERNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FREZALIA
Middle Name:LAVERNE
Last Name:OLIVER
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 1:1776 N JEFFERSON ST NE # -
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2229
Mailing Address - Country:US
Mailing Address - Phone:478-451-3112
Mailing Address - Fax:478-451-0626
Practice Address - Street 1:1776 N JEFFERSON ST NE # -
Practice Address - Street 2:SUITE B
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2229
Practice Address - Country:US
Practice Address - Phone:478-451-3112
Practice Address - Fax:478-451-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0006581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR61751Medicare UPIN
80BBGLVMedicare PIN