Healthcare Provider Details

I. General information

NPI: 1992434807
Provider Name (Legal Business Name): OLIVIA LOWE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CESAR E CHAVEZ AVE
LANSING MI
48906-4384
US

IV. Provider business mailing address

544 SPOKANE AVE
LANSING MI
48910-5449
US

V. Phone/Fax

Practice location:
  • Phone: 517-273-2706
  • Fax:
Mailing address:
  • Phone: 517-249-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: