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General NPI Number Information
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NPI Number | 1558040972
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Entity Type | Individual
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Provider Name | OLIVIA PAIGE HANOVER LLPC
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Gender | Female
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 935 N WASHINGTON AVE STE L1
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City | LANSING
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State | MI
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Zip | 48906-5137
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Country | US
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Telephone | 517-301-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 226 WILDEMERE DR
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City | MASON
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State | MI
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Zip | 48854-1360
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Country | US
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Telephone | 517-290-2588
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Fax |
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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 | 6451023136
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License Number State | MI
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