Provider Demographics
NPI:1952426090
Name:ADAIR, OLIVIA JOHANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOHANNA
Last Name:ADAIR
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 1:3013 NEVAN LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6468
Mailing Address - Country:US
Mailing Address - Phone:910-675-3533
Mailing Address - Fax:910-675-3405
Practice Address - Street 1:5000 LAMBS PATH WAY
Practice Address - Street 2:
Practice Address - City:CASTLE HAYNE
Practice Address - State:NC
Practice Address - Zip Code:28429-6311
Practice Address - Country:US
Practice Address - Phone:910-675-3533
Practice Address - Fax:910-675-3405
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106516Medicaid