Provider Demographics
NPI:1396233144
Name:OLIVER, TOMEIKA S (LISW-S, LICDC)
Entity type:Individual
Prefix:
First Name:TOMEIKA
Middle Name:S
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SUPERIOR AVE E STE 308
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2144
Mailing Address - Country:US
Mailing Address - Phone:440-723-4609
Mailing Address - Fax:
Practice Address - Street 1:1900 SUPERIOR AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2141
Practice Address - Country:US
Practice Address - Phone:440-723-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162145101YA0400X
OHI.20021681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)