Provider Demographics
NPI:1194559005
Name:OLSON, MORGAN OLIVIA
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:OLIVIA
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 CLEARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-9611
Mailing Address - Country:US
Mailing Address - Phone:704-975-3969
Mailing Address - Fax:
Practice Address - Street 1:1118 SAM NEWELL RD STE D4
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5162
Practice Address - Country:US
Practice Address - Phone:248-396-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21865101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)