Healthcare Provider Details

I. General information

NPI: 1912835232
Provider Name (Legal Business Name): TANGELA LANELL OLIVER LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 BREEZEWOOD AVE STE 203
FAYETTEVILLE NC
28303-5281
US

IV. Provider business mailing address

2931 BREEZEWOOD AVE STE 203
FAYETTEVILLE NC
28303-5281
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-6011
  • Fax: 910-764-6961
Mailing address:
  • Phone: 910-491-6011
  • Fax: 910-764-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: