MEDICARE: DENISE K. OLIVE M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	002582	GA

General Provider Information

NPI Number	:	1851413322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE K. OLIVE M.S.

Provider Business Mailing Address
First Line	:	294 LAUREL LN
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-3623
Country	:	US
Telephone Number	:	770-843-7506
Fax Number	:

Provider Business Practice Location Address
First Line	:	6255 BARFIELD RD NE
Second Line	:	SUITE 175
City	:	ATLANTA
State	:	GA
Zip	:	30328-4319
Country	:	US
Telephone Number	:	770-843-7506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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