MEDICARE: OLIVIA JOHANNA ADAIR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C005431	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952426090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA JOHANNA ADAIR LCSW

Provider Business Mailing Address
First Line	:	3013 NEVAN LN
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-6468
Country	:	US
Telephone Number	:	910-675-3533
Fax Number	:	910-675-3405

Provider Business Practice Location Address
First Line	:	5000 LAMBS PATH WAY
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6311
Country	:	US
Telephone Number	:	910-675-3533
Fax Number	:	910-675-3405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/09/2007

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