Provider Demographics
NPI:1902635766
Name:OLINOVA, ANNA A (APCC#14943)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:A
Last Name:OLINOVA
Suffix:
Gender:F
Credentials:APCC#14943
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3671
Mailing Address - Country:US
Mailing Address - Phone:310-739-8583
Mailing Address - Fax:
Practice Address - Street 1:1353 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3671
Practice Address - Country:US
Practice Address - Phone:310-739-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health