Healthcare Provider Details

I. General information

NPI: 1104452010
Provider Name (Legal Business Name): OLIVIA HOUCHINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA MENDOZA

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

IV. Provider business mailing address

207 N 4TH AVE
HOPEWELL VA
23860-2503
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-0700
  • Fax:
Mailing address:
  • Phone: 804-541-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024179022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: