Provider Demographics
NPI:1720893498
Name:PATRICK, OLIVIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 WILLIE JACOBS AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8075
Mailing Address - Country:US
Mailing Address - Phone:910-317-2704
Mailing Address - Fax:
Practice Address - Street 1:634 WILLIE JACOBS AVE
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-8075
Practice Address - Country:US
Practice Address - Phone:910-317-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0179741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical