Healthcare Provider Details

I. General information

NPI: 1750980421
Provider Name (Legal Business Name): CHAD OLLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N HIGHLAND ST UNIT 817
ARLINGTON VA
22201-2187
US

IV. Provider business mailing address

1020 N HIGHLAND ST UNIT 817
ARLINGTON VA
22201-2187
US

V. Phone/Fax

Practice location:
  • Phone: 414-305-2110
  • Fax:
Mailing address:
  • Phone: 414-305-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSYA00298
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: