Provider Demographics
NPI:1750518221
Name:OLIVER, DEBBIE (MFT)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1023 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4112
Mailing Address - Country:US
Mailing Address - Phone:707-522-0475
Mailing Address - Fax:
Practice Address - Street 1:1023 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4112
Practice Address - Country:US
Practice Address - Phone:707-522-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist