Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | I-06235 | NM |
Y | 1041C0700X | Clinical Social Worker | C-06235 | NM |
NPI | 1003008202 |
---|---|
Provider Name | Angela D. Oliver |
First Address | El Prado, NM 87529-0278 |
Second Address | El Prado, NM 87529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99881365 | (05) | NM |