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General NPI Number Information
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NPI Number | 1992868749
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Entity Type | Individual
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Provider Name | KEVIN PAUL OLIVER MA, MPA, LCAS
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 2505 COURT DR
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City | GASTONIA
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State | NC
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Zip | 28054-2140
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Country | US
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Telephone | 704-921-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 WILD NURSERY CT
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City | CHARLOTTE
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State | NC
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Zip | 28215-5345
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Country | US
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Telephone | 704-921-3070
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1035
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License Number State | NC
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