Provider Demographics
NPI:1912442260
Name:OLIVER, SUSAN ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 WINDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-7063
Mailing Address - Country:US
Mailing Address - Phone:866-796-0530
Mailing Address - Fax:
Practice Address - Street 1:5210 BELFORT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6024
Practice Address - Country:US
Practice Address - Phone:866-796-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH7191OtherLICENSED MENTAL HEALTH COUNSELOR