Individual
OLGA VICTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-5060
Mailing address
7436 CATENA LN, MYRTLE BEACH, SC 29572-8031
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301092578
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327877
—
SC
Enumeration date
07/11/2008
Last updated
02/11/2022
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