Healthcare Provider Details

I. General information

NPI: 1023937703
Provider Name (Legal Business Name): OLIVIA MIJARO LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 ARCO CORPORATE DR STE 120
RALEIGH NC
27617-2026
US

IV. Provider business mailing address

1110 APPLEGATE PKWY
WAXHAW NC
28173-6728
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-7600
  • Fax:
Mailing address:
  • Phone: 646-727-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: