Healthcare Provider Details

I. General information

NPI: 1033013271
Provider Name (Legal Business Name): APEX PERFORMANCE PSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LATROBE DR STE 130
CHARLOTTE NC
28211-1367
US

IV. Provider business mailing address

3701 LATROBE DR STE 130
CHARLOTTE NC
28211-1367
US

V. Phone/Fax

Practice location:
  • Phone: 336-604-6520
  • Fax:
Mailing address:
  • Phone: 336-604-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: BENJAMIN MARK OLIVA
Title or Position: OWNER
Credential: PSY.D.
Phone: 336-604-6520