Provider Demographics
NPI:1053718627
Name:OLIVER-PAGE, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OLIVER-PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 BARRETT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3525
Mailing Address - Country:US
Mailing Address - Phone:313-841-8900
Mailing Address - Fax:313-841-3756
Practice Address - Street 1:5909 BARRETT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3525
Practice Address - Country:US
Practice Address - Phone:313-841-8900
Practice Address - Fax:313-841-3756
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker