Provider Demographics
NPI:1285752808
Name:OLIVER, LISA (BS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAHONE ST
Mailing Address - Street 2:#11
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8933
Mailing Address - Country:US
Mailing Address - Phone:919-643-5502
Mailing Address - Fax:919-643-5550
Practice Address - Street 1:1000 CORPORATE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8535
Practice Address - Country:US
Practice Address - Phone:919-643-5502
Practice Address - Fax:919-543-5550
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306875695Medicaid