Healthcare Provider Details

I. General information

NPI: 1508788860
Provider Name (Legal Business Name): OLIVIA W. HALLMARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 FAIRVIEW RD STE 700
CHARLOTTE NC
28210-0085
US

IV. Provider business mailing address

7202 SUTTER CREEK LN
CHARLOTTE NC
28227-3013
US

V. Phone/Fax

Practice location:
  • Phone: 980-255-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA232631
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: