Provider Demographics
NPI:1841952306
Name:ISMAIL, OLIVIA HOGAN (LCSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HOGAN
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6233
Mailing Address - Country:US
Mailing Address - Phone:601-218-8508
Mailing Address - Fax:
Practice Address - Street 1:615 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3835
Practice Address - Country:US
Practice Address - Phone:601-336-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC90991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical