Provider Demographics
NPI:1104328137
Name:MCGINNIS, OLIVIA ROSE (MS, ADC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MS, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:AL
Mailing Address - Zip Code:35987-1838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 CAMERON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3714
Practice Address - Country:US
Practice Address - Phone:318-323-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator