Provider Demographics
NPI:1316717754
Name:OLIVER, SHIFFON P (CRC, LCMHCA)
Entity type:Individual
Prefix:
First Name:SHIFFON
Middle Name:P
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 FARMINGTON DR APT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5784
Mailing Address - Country:US
Mailing Address - Phone:336-988-2974
Mailing Address - Fax:
Practice Address - Street 1:109 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2528
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health