Provider Demographics
NPI:1699790956
Name:BEAUCHAIN, OLIVIA S (LCSW)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:S
Last Name:BEAUCHAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:SCARBOROUGH
Other - Last Name:CRANFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0475
Mailing Address - Country:US
Mailing Address - Phone:770-271-4712
Mailing Address - Fax:770-271-4711
Practice Address - Street 1:898 SCALES RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1830
Practice Address - Country:US
Practice Address - Phone:770-271-4712
Practice Address - Fax:770-271-4711
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036071041C0700X
FLSW56691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBGHCMedicare PIN
FLZ9989BMedicare PIN