Healthcare Provider Details

I. General information

NPI: 1255082996
Provider Name (Legal Business Name): DEANDRA MICHELLE OLIVER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E NUNNALLY ST
BURKEVILLE VA
23922-3127
US

IV. Provider business mailing address

515 E NUNNALLY ST STE B
BURKEVILLE VA
23922-3127
US

V. Phone/Fax

Practice location:
  • Phone: 434-254-9176
  • Fax:
Mailing address:
  • Phone: 434-254-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number070414491
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: