Provider Demographics
NPI:1396773149
Name:OLSON, JEAN L (LCSW BCD)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:L P
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4900 WATERS EDGE DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606
Mailing Address - Country:US
Mailing Address - Phone:919-859-5206
Mailing Address - Fax:
Practice Address - Street 1:4900 WATERS EDGE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606
Practice Address - Country:US
Practice Address - Phone:919-859-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0003401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
036996OtherVALUE OPTIONS
11339428OtherCAQH PROVIDER
6267363OtherUBH
640S2OtherBCBS
NC10S0726OtherCIGNA
19082OtherMAGELLAN
6267363OtherUBH