Provider Demographics
NPI:1932395522
Name:OLIVER, JAVON CORY (MS)
Entity Type:Individual
Prefix:MR
First Name:JAVON
Middle Name:CORY
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 THORNBERRY DR E
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5061
Mailing Address - Country:US
Mailing Address - Phone:202-340-1953
Mailing Address - Fax:
Practice Address - Street 1:418 SHEPHERD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5944
Practice Address - Country:US
Practice Address - Phone:202-340-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14310101YP2500X, 101YM0800X
MDLC2445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional