Provider Demographics
NPI:1427708403
Name:OLIVER, BETH (ATR-P, RES IN COUN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ATR-P, RES IN COUN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7605 COSGROVE PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2605
Mailing Address - Country:US
Mailing Address - Phone:703-864-3170
Mailing Address - Fax:
Practice Address - Street 1:7605 COSGROVE PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2605
Practice Address - Country:US
Practice Address - Phone:571-380-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA074014659101Y00000X
22-030221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty