Healthcare Provider Details

I. General information

NPI: 1962138859
Provider Name (Legal Business Name): OLIVIA RAE HILDRETH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 FAIRVIEW RD STE 102
CHARLOTTE NC
28210-3111
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 102
CHARLOTTE NC
28210-3111
US

V. Phone/Fax

Practice location:
  • Phone: 980-701-4065
  • Fax: 980-701-4075
Mailing address:
  • Phone: 980-701-4065
  • Fax: 980-701-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017953
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: