Healthcare Provider Details

I. General information

NPI: 1003486085
Provider Name (Legal Business Name): ASHLEY NOEL OLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 2ND ST STE 225
NAPA CA
94559-3030
US

IV. Provider business mailing address

1001 2ND ST STE 225
NAPA CA
94559-3030
US

V. Phone/Fax

Practice location:
  • Phone: 855-427-2778
  • Fax: 707-927-0069
Mailing address:
  • Phone: 855-427-2778
  • Fax: 707-927-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20599
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: