Provider Demographics
NPI:1124286638
Name:AGGAS, OLIVIA STEPHANIE (ADTSIII)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:STEPHANIE
Last Name:AGGAS
Suffix:
Gender:
Credentials:ADTSIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6009
Mailing Address - Country:US
Mailing Address - Phone:805-662-1774
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6009
Practice Address - Country:US
Practice Address - Phone:805-662-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7957101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)