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General NPI Number Information
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NPI Number | 1003008202
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Entity Type | Individual
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Provider Name | ANGELA D. OLIVER LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 244 TUNE DRIVE
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City | EL PRADO
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State | NM
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Zip | 87529
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Country | US
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Telephone | 575-751-9858
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Fax | 575-751-9858
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | EL PRADO
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State | NM
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Zip | 87529-0278
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Country | US
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Telephone | 575-751-9858
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Fax | 575-613-1506
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | I-06235
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-06235
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License Number State | NM
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