Provider Demographics
NPI:1053433359
Name:OLSON, TINA R (LICSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:OLSON
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 1:65 HOOKSETT TPKE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8402
Mailing Address - Country:US
Mailing Address - Phone:603-726-1526
Mailing Address - Fax:
Practice Address - Street 1:33 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4049
Practice Address - Country:US
Practice Address - Phone:603-226-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical