Provider Demographics
NPI:1285782722
Name:OLSON, JANICE M (LPC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 EBENEZER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1062
Mailing Address - Country:US
Mailing Address - Phone:803-448-7079
Mailing Address - Fax:803-328-0336
Practice Address - Street 1:2025 EBENEZER RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1062
Practice Address - Country:US
Practice Address - Phone:803-448-7079
Practice Address - Fax:803-328-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPC4792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1178Medicaid