Healthcare Provider Details

I. General information

NPI: 1013770114
Provider Name (Legal Business Name): OLIVIA FRANCES NEELY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 MARTIN LUTHER KING PKWY STE 205
DURHAM NC
27707-3586
US

IV. Provider business mailing address

1802 MARTIN LUTHER KING PKWY STE 205
DURHAM NC
27707-3586
US

V. Phone/Fax

Practice location:
  • Phone: 661-803-7113
  • Fax:
Mailing address:
  • Phone: 661-803-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: