Individual
WENDY FAVIOLA OLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LCSW-A
Contact information
Practice address
301 FISHER ST, KEESLER AFB, MS 39534-2508
(228) 376-5046
Mailing address
301 FISHER ST, KEESLER AFB, MS 39534-2508
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
P017413
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8302263
—
NC
Enumeration date
04/02/2015
Last updated
09/26/2024
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