Provider Demographics
NPI:1912663469
Name:MONTGOMERY, OLGA (LCSW)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:KOFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9327 MIDLOTHIAN TPKE STE 2G
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4944
Mailing Address - Country:US
Mailing Address - Phone:804-404-6008
Mailing Address - Fax:804-414-7558
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 2G
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4944
Practice Address - Country:US
Practice Address - Phone:804-404-6008
Practice Address - Fax:804-414-7558
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040152461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical