Provider Demographics
NPI:1962162487
Name:OLIVER, KIA (LICSW)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 GEORGIA AVENUE NW
Mailing Address - Street 2:SUITE TE 1 - 615
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6912
Mailing Address - Country:US
Mailing Address - Phone:240-639-2475
Mailing Address - Fax:
Practice Address - Street 1:6218 GEORGIA AVENUE NW STE 1 - 615
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2001
Practice Address - Country:US
Practice Address - Phone:240-639-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500826771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical